losartan-potassium and Postoperative-Complications

The renoprotective effects of erythropoietin (EPO) are well-known; however, the optimal timing of EPO administration remains controversial. Red blood cell (RBC) transfusion is an independent risk factor for cardiac surgery-associated acute kidney injury (CSA-AKI). We aimed to evaluate the efficacy of EPO on CSA-AKI and RBC transfusion according to the timing of administration.. We searched the Cochrane Library, EMBASE, and MEDLINE databases for randomized controlled trials. The primary outcome was the incidence of CSA-AKI following perioperative EPO administration, and the secondary outcomes were changes in serum creatinine, S-cystatin C, S-neutrophil gelatinase-associated lipocalin, urinary neutrophil gelatinase-associated lipocalin, length of hospital and intensive care unit (ICU) stay, volume of RBC transfusion, and mortality. The subgroup analysis was stratified according to the timing of EPO administration in relation to surgery.. Eight randomized controlled trials with 610 patients were included in the study. EPO administration significantly decreased the incidence of CSA-AKI (odds ratio: 0.60, 95% confidence interval [CI]: 0.43-0.85, P = .004; I2 = 52%; P for heterogeneity = .04), intra-operative RBC transfusion (standardized mean difference: -0.30, 95% CI: -0.55 to -0.05, P = .02; I2 = 15%, P for heterogeneity = .31), and hospital length of stay (mean difference: -1.54 days, 95% CI: -2.70 to -0.39, P = .009; I2 = 75%, P for heterogeneity = .001) compared with control groups. Subgroup analyses revealed that pre-operative EPO treatment significantly reduced the incidence of CSA-AKI, intra-operative RBC transfusion, serum creatinine, and length of hospital and ICU stay.. Pre-operative administration of EPO may reduce the incidence of CSA-AKI and RBC transfusion, but not in patients administered EPO during the intra-operative or postoperative period. Therefore, pre-operative EPO treatment can be considered to improve postoperative outcomes by decreasing the length of hospital and ICU stay in patients undergoing cardiac surgery.

Topics: Acute Kidney Injury; Cardiac Surgical Procedures; Creatinine; Erythrocyte Transfusion; Erythropoietin; Humans; Lipocalin-2; Perioperative Care; Postoperative Complications; Randomized Controlled Trials as Topic

The protective effect of recombinant human erythropoietin (rHuEPO) on kidney transplantation has not been established. Therefore, we conducted a systematic review and meta-analysis to evaluate the potential influence of rHuEPO on transplanted kidneys.. To identify relevant studies, we searched electronic databases (PubMed, Medline, EMBASE, Ovid, the Cochrane Library, and major nephrology journals) from inception until June 15, 2018. Two independent reviewers assessed study quality. The systematic review and meta-analysis were performed with fixed- or random-effects models according to heterogeneity, and results are expressed as risk ratios (RR) or weighted mean differences.. Six randomized controlled trials with a total of 435 patients met the inclusion criteria. rHuEPO, compared with placebo, had no statistically significant effect on delayed graft function (RR = 0.89, 95% confidence interval [CI] , 0.73 to 1.07; P = 0.22) and slow graft function (RR = 0.93, 95% CI, 0.60 to 1.43; P = 0.73). The rHuEPO and control groups did not differ in thromboembolic events, mortality, acute rejection, and blood transfusion. A significant difference was found in long-term estimated glomerular filtration rate (RR = 3.65, 95% CI, -4.45 to 11.75; P = 0.003).. Our findings suggests that rHuEPO has a limited nephroprotective effect in patients undergoing kidney transplantation and does not increase the susceptibility to adverse events.

Topics: Erythropoietin; Humans; Kidney Transplantation; Postoperative Complications; Recombinant Proteins

Anemia is a common finding in the perioperative setting with significant untoward consequences including worsening of outcomes and diminished quality of life as well as increased risk of allogeneic blood transfusions. Here, we present 3 cases that illustrate how anemia can be perioperatively managed in patients undergoing cardiac, orthopedic, and oncology surgeries. Timely detection of anemia prior to high-blood loss surgeries can allow clinicians to manage it and optimize hemoglobin level, making patients better prepared for the surgery. Treatment of anemia should be guided by the etiology and may include erythropoietic agents, folic acid, B12, and iron preparations. Other blood management strategies geared toward reducing surgical blood loss such as autologous transfusion techniques and agents to optimize hemostasis are used during surgery and in the immediate postoperative period. Patients should be closely monitored following surgery for signs of ongoing bleeding in need of control. Finally, screening for and management of anemia should continue in the postoperative and postdischarge period, as persistence and recurrence of anemia can further undermine patient's outcomes.

Topics: Anemia; Blood Loss, Surgical; Blood Transfusion, Autologous; Erythrocyte Transfusion; Erythropoietin; Humans; Iron; Perioperative Care; Postoperative Complications

The role of perioperative erythropoietin (EPO) for preventing cardiac surgery associated acute kidney injury (CSA-AKI) remains uncertain with published trials producing conflicting results. Perspective into the factors at work is needed, due to ongoing uncertainty.. We undertook the systematic review and meta-analysis of randomised-controlled trials (RCTs) using random-effects modelling. The primary outcome was safety and efficacy of perioperative EPO to prevent CSA-AKI and the secondary outcomes were change in serum creatinine, urinary neutrophil gelatinase-associated lipocalin, time in ICU, rates of postoperative transfusions, haemodialysis, and mortality. Subgroup analysis explored the effect of the timing of the EPO dose in relation to surgery, the dose response, and the impact of the preoperative risk for CSA-AKI for the patient group.. Our findings suggest that administering EPO before anaesthesia is emerging as an important factor for efficacy. Erythropoietin may have a role in preventing CSA-AKI, however, additional high-quality prospective studies are warranted, particularly aimed at describing the methodological components, such as the timing and size of the dose, which potentiate the cytoprotective effect of EPO in the clinical setting.

Topics: Acute Kidney Injury; Cardiac Surgical Procedures; Erythropoietin; Female; Humans; Male; Perioperative Care; Postoperative Complications

The aim was to investigate the efficacy and safety of erythropoietin (EPO) to prevent acute kidney injury (AKI) in patients with critical illness or perioperative care.. Randomized controlled trials comparing EPO with placebo for AKI prevention in adult patients with critical illness or perioperative care were searched in MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials, the Web of Science, and Clinical Trials.gov until October 2014. The outcomes of interest included the incidence of AKI, dialysis requirement, mortality, and adverse event. Fixed effect model was used to calculate the pooled risk ratio (RR) and 95% confidence interval (CI) for eligible studies.. Ten randomized controlled trials involving 2759 participants were identified and included in the analysis. Compared with placebo, EPO administration did not reduce the incidence of AKI (RR, 0.97; 95% CI, 0.79-1.19; P = 0.782), dialysis requirement (RR, 0.72; 95% CI, 0.31-1.70; P = 0.457), or mortality (RR, 0.96; 95% CI, 0.78-1.18; P = 0.705). Moreover, EPO had no effect on the risk of adverse events, but estimations of RR were difficult due to their relatively infrequent occurrence.. This meta-analysis suggests that prophylactic administration of EPO in patients with critical illness or perioperative care does not prevent AKI, dialysis requirement, or mortality.

Topics: Acute Kidney Injury; Adult; Aged; Critical Illness; Erythropoietin; Female; Humans; Incidence; Male; Middle Aged; Odds Ratio; Postoperative Complications; Preoperative Care; Randomized Controlled Trials as Topic; Renal Dialysis; Risk Assessment; Risk Factors; Time Factors; Treatment Outcome

Topics: Anemia, Sickle Cell; Biopsy; Complementary Therapies; Diagnosis, Differential; Erythropoietin; Hemochromatosis; Hepatitis C, Chronic; Humans; Iron; Kidney Transplantation; Liver; Metabolic Syndrome; Phlebotomy; Polycythemia; Polycythemia Vera; Porphyria Cutanea Tarda; Postoperative Complications

Elective total knee arthroplasty is frequently associated with considerable blood loss and a concomitant decline in hemoglobin postoperatively. This often leads to high rates of allogeneic transfusions, with reports of up to 69%, to treat postoperative anemia. Allogeneic blood transfusions have been shown to be an independent risk factor for increased adverse outcomes, such as prolonged length of hospital stay and postoperative infections. Although multiple preoperative blood management strategies have been proposed, there are no concise guidelines, as few studies have compared the relative efficacy of these techniques. The aim of this review was to evaluate current evidence on the various preoperative blood management strategies for patients undergoing total knee arthroplasty and to provide an overview of the safety and efficacy of these practices. Specifically, we evaluated preoperative autologous blood donation, iron therapy, and intravenous erythropoietin. Current evidence suggests that these techniques independently may be effective at reducing the incidence of allogeneic blood transfusions, correcting preoperative, and preventing postoperative anemia. However, more studies are necessary to evaluate combination protocols, as well as the cost-effectiveness and safety of these practices as part of routine preoperative blood management for total knee arthroplasty.

Topics: Algorithms; Anemia; Arthroplasty, Replacement, Knee; Blood Loss, Surgical; Blood Transfusion, Autologous; Erythropoietin; Humans; Injections, Intravenous; Iron; Postoperative Complications; Preoperative Care; Trace Elements

Advances in renal transplantation management have proven to be beneficial in improving graft and patient survival. One of the properties of a well-functioning renal allograft is the secretion of adequate amounts of the hormone erythropoietin to stimulate erythropoiesis. Posttransplantation anemia (PTA) may occur at any point in time following transplantation, and the cause is multifactoral. Much of our understanding of PTA is based on studies of adult transplant recipients. The limited number of studies that have been reported on pediatric renal transplant patients appear to indicate that PTA is prevalent in this patient population. Erythropoietin deficiency or resistance is commonly associated with iron deficiency. An understanding of the risk factors, pathophysiology and management of PTA in the pediatric renal transplant population may provide guidelines for clinicians and researchers in the pursuit of larger prospective randomized control studies aimed at improving our limited knowledge of PTA. Recognition of PTA through regular screening and evaluation of the multiple factors that may contribute to its development are recommended after transplantation.

Topics: Anemia; Child; Erythropoietin; Humans; Kidney Transplantation; Postoperative Complications; Risk Factors

Topics: Acetamides; Aged; Anemia, Refractory; Anemia, Sideroblastic; Anti-Bacterial Agents; Arthroplasty; Arthroplasty, Replacement, Hip; Arthroplasty, Replacement, Knee; Combined Modality Therapy; Comorbidity; Diabetes Mellitus, Type 2; Diagnosis, Differential; Erythrocyte Transfusion; Erythropoietin; Female; Humans; Linezolid; Methicillin-Resistant Staphylococcus aureus; Obesity, Morbid; Oxazolidinones; Polypharmacy; Postoperative Complications; Prosthesis-Related Infections; Reoperation

Patient blood management (PBM) is a patient-specific multidisciplinary, multimodal, evidence-based concept to appropriately conserve and manage a patient's own blood as a vital resource. PBM is based on 3 pillars: the first is the optimization of the patient's endogenous red cell mass, the second is the minimization of bleeding and blood loss and the third involves harnessing and optimizing the patient-specific physiological tolerance of anemia, including adopting more restrictive transfusion thresholds. PBM primarily identifies patients at risk of transfusion and provides a management plan aimed at reducing or eliminating the need for allogeneic transfusion, thus reducing the inherent risks, inventory pressures and the escalating costs associated with transfusion. PBM is applicable to surgical and medical patients. The application of PBM systematically reduces the impact of 3 major contributors to negative outcome: anemia, blood loss and transfusion.

Topics: Anemia; Austria; Benchmarking; Blood Transfusion; Erythrocyte Transfusion; Erythrocyte Volume; Erythropoietin; Hematologic Diseases; Humans; Intraoperative Care; Operative Blood Salvage; Patient Care Management; Perioperative Care; Plasma Substitutes; Platelet Transfusion; Postoperative Care; Postoperative Complications; Preoperative Care

Advances in the neurobiology of growth factors, neural development, and prevention of cell death have resulted in a heightened clinical interest for the development of protective and regenerative neuromodulatory strategies for the cavernous nerves (CNs), as therapies for prostate cancer and other pelvic malignancies often result in neuronal damage and debilitating loss of sexual function. Nitric oxide released from the axonal end plates of these nerves within the corpora cavernosa causes relaxation of smooth muscle, initiating the haemodynamic changes of penile erection as well as contributing to maintained tumescence; the loss of CN function is primarily responsible for the development of erectile dysfunction (ED) after pelvic surgery and serves as the primary target for potential neuroprotective or regenerative strategies. Evidence from pre-clinical studies for select neuromodulatory approaches is reviewed, including neurotrophins, glial cell line-derived neurotrophic factors (GDNF), bone morphogenic proteins, immunophilin ligands, erythropoetin (EPO), and stem cells.

Topics: Animals; Bone Morphogenetic Proteins; Brain-Derived Neurotrophic Factor; Erectile Dysfunction; Erythropoietin; Glial Cell Line-Derived Neurotrophic Factor; Growth Differentiation Factor 5; Humans; Immunophilins; Male; Nerve Growth Factors; Neurotransmitter Agents; Penis; Peripheral Nerve Injuries; Postoperative Complications; Stem Cell Transplantation

Cardiovascular surgery is constantly progressing. However, the prevalence of central nervous system injury is greater after operations on the aortic arch than after other types of aortic or cardiac surgery. The central nervous system injury is a frequent cause of death or complications after such operations and is likely to occur as a result of the embolization of particulate matter or severe global ischemia during the interval of circulatory arrest. Several different methods are currently being used to protect them during operations on the aortic arch. This thesis is organized about the protection methods for these procedures.

Topics: Aorta, Thoracic; Brain Ischemia; Cardiopulmonary Bypass; Cardiovascular Surgical Procedures; Cerebrospinal Fluid; Drainage; Erythropoietin; Evoked Potentials, Motor; Heart Arrest, Induced; Humans; Hypothermia, Induced; Intercostal Muscles; Intraoperative Complications; Monitoring, Intraoperative; Perfusion; Perioperative Care; Postoperative Complications; Spinal Cord Ischemia

Preoperative autologous blood donation (PABD) with no risk of blood-borne infection transmission has been considered the supreme blood transfusion therapy, and it has been reported to decrease incidence of postoperative deep-vein thrombosis. However, the need for PABD has decreased in the USA, because 1) risk of blood-borne infection transmission through allogeneic blood transfusion (ABT) has decreased after introduction of nucleic acid amplification test (NAT), and 2) blood collection-induced anemia has been found in many cases due to inapplicability of erythropoietin (rEPO). ABT risks are decreasing in Japan as in the USA, however, ABT has several issues proper to Japan, such as, outpacing of blood demand over supply in the near future and increase of HIV positive donors. Also, as rEPO can be used in Japan, PABD-induced anemia risks are low. Accordingly, necessity of PABD should increase in Japan. However, as those who usually perform PABD in Japan are surgeons, big issues arise such as bacterial contamination during blood collection and ABO incompatibility during transfusion. Underutilization of PABD in gastrointestinal cancer surgery should also be addressed. Appropriate technique and methodology must be established to increase the safety of PABD and to spread PABD in cancer surgery.

Topics: Anemia; Blood Donors; Blood Group Incompatibility; Blood Transfusion, Autologous; Cost-Benefit Analysis; Erythropoietin; HIV Infections; Humans; Japan; Medical Errors; Postoperative Complications; Preoperative Care; Recombinant Proteins; Safety; Venous Thrombosis

Perioperative anemia is common and is associated with increased need for blood transfusion in the perioperative period. Perioperative anemia has also been linked to increased morbidity and mortality in surgical patients. Anemia may impede a patient's ability to recover fully and participate in postoperative rehabilitation. Pre-operative treatment of anemia is associated with a reduction in the need for blood transfusion in the perioperative period. Additional advances in surgical technology that reduce blood loss intraoperatively are associated with a reduction in postoperative anemia and should be used whenever possible. All strategies to prevent anemia in the perioperative period should be considered in an effort to minimize exposure of surgical patients to blood transfusion.

Topics: Anemia; Blood Transfusion; Combined Modality Therapy; Epoetin Alfa; Erythropoietin; Female; Hemoglobins; Humans; Male; Perioperative Care; Postoperative Care; Postoperative Complications; Preoperative Care; Primary Prevention; Recombinant Proteins; Risk Assessment; Severity of Illness Index; Surgical Procedures, Operative

Recombinant human erythropoietin (rHuEPO) and intravenous (i.v.) iron administration may be useful tools to save blood in surgery. In the perioperative period, rHuEPO should be used in slightly anemic patients for whom an autologous predonation program is not recommended (or feasible). In such cases, i.v. iron is only given if there is a functional or real iron deficiency state. In the post-operative period, i.v. iron is administered in association with rHuEPO in an attempt to rapidly correct severe post-operative anemia. The same regimen is used for patients undergoing surgery for inflammatory bowel disease and rheumatoid arthritis. Finally, other particular categories of patients, such as those with reduced body weight (< 50 kg), candidates for surgery with increased blood needs (> 5 units), or those with a too-short period of time before surgery, also benefit from the administration of these two drugs.

Topics: Administration, Oral; Adolescent; Adult; Aged; Anemia; Arthritis, Rheumatoid; Blood Loss, Surgical; Blood Transfusion, Autologous; Erythropoietin; Hemoglobins; Humans; Inflammatory Bowel Diseases; Infusions, Intravenous; Iron; Iron Deficiencies; Postoperative Care; Postoperative Complications; Preoperative Care; Randomized Controlled Trials as Topic; Recombinant Proteins; Risk Factors; Surgical Procedures, Operative; Time Factors

The introduction of recombinant human erythropoietin (RHuEPO) has revolutionised the treatment of patients with anaemia of chronic renal disease. Clinical studies have demonstrated that RHuEPO is also useful in various non-uraemic conditions including haematological and oncological disorders, prematurity, HIV infection, and perioperative therapies. Besides highlighting both the historical and functional aspects of RHuEPO, this review discusses the applications of RHuEPO in clinical practice and the potential problems of RHuEPO treatment.

Topics: Anemia; Blood Transfusion; Erythropoietin; Hematinics; Humans; Kidney Failure, Chronic; Kidney Transplantation; Neoplasms; Postoperative Complications; Recombinant Proteins; Renal Dialysis; Treatment Outcome

Topics: Aged; Erythropoietin; Fatal Outcome; Hematopoiesis, Extramedullary; Humans; Iron Overload; Leukemia, Erythroblastic, Acute; Male; Postoperative Complications; Primary Myelofibrosis; Spleen; Splenectomy; Splenomegaly; Transfusion Reaction

The clinical management of gynaecological cancer patients has been mainly focused on prolonging the survival of the patients. Thus, research on MEDLINE using as keywords 'Quality of Life' (QoL) allowed us to identify few papers which reported data on QoL in gynecological oncology. However, the assessment of QoL is becoming one of the most important issues in gynecological oncology, and there is a growing interest in including quality of life measurements in clinical trials. In fact, in several randomised trials on ovarian cancer now ongoing in Europe, the evaluation of QoL has been planned. The one underlying this article focuses on the symptoms and problems particular to gynecologic cancer and the treatments of them that could affect quality of life evaluations. These include limitations of sexual activity and fertility, early menopause, chemotherapy induced toxicity, and loss of body image. In this report, we will discuss the aspects affecting the QoL in gynaecological cancer in relation to surgical treatment, medical therapy, and follow-up.

Topics: Anemia; Clinical Trials as Topic; Erythropoietin; Female; Follow-Up Studies; Genetic Counseling; Genital Neoplasms, Female; Humans; Outcome Assessment, Health Care; Postoperative Complications; Quality of Life; Sexual Dysfunctions, Psychological

Data from four prospective, multicenter, randomized studies involving 869 major, elective orthopedic surgery patients were examined by means of a retrospective integrated analysis to evaluate whether perioperative Epoetin alfa use was associated with the occurrence of thrombotic/vascular events. The incidence of thrombotic/vascular events was similar between 619 patients treated with Epoetin alfa and 250 patients receiving placebo (7.4% versus 8.0%, respectively). Regression analyses identified age, cardiac history, hypertension, and cardiac medications, but not Epoetin alfa, as risk factors for thrombotic/vascular events. The analysis did not implicate an increase in the rate of rise in hematocrit or maximum hematocrit obtained prior to surgery as contributors to thrombotic events. Thus, Epoetin alfa, which enhances preoperative erythropoiesis and increases hematocrit, did not affect the probability of thrombotic/vascular events.

Topics: Epoetin Alfa; Erythrocyte Count; Erythropoietin; Hematinics; Hematocrit; Hip; Humans; Incidence; Knee; Multicenter Studies as Topic; Placebos; Postoperative Complications; Prospective Studies; Randomized Controlled Trials as Topic; Recombinant Proteins; Regression Analysis; Retrospective Studies; Risk Factors; Thrombosis; Vascular Diseases

Topics: Adult; Aged; Anemia; Blood Transfusion; Bone Marrow Transplantation; Cardiac Surgical Procedures; Endocarditis, Bacterial; Erythropoietin; Extracorporeal Circulation; Heart Valve Diseases; Humans; Middle Aged; Postoperative Complications

Under normal physiologic conditions the level of circulating red blood cells is regulated precisely by the glycoprotein erythropoietin. In major elective surgery, patients who are participating in preoperative autologous blood donation or who are anemic may not have the capacity to manufacture sufficient red blood cells in response to increases in endogenous erythropoietin that is sufficient to avoid perioperative allogeneic blood transfusion. In these patients pharmacologic doses of recombinant human erythropoietin (Epoetin alfa) have been shown to accelerate erythropoiesis, thereby increasing preoperative red blood cell production, hematocrit level, and hemoglobin concentration and reducing exposure to allogeneic blood transfusion. In four large multicenter studies, 869 patients undergoing major elective surgery were treated with a daily regimen (300 or 100 IU/kg x 14 or 15 doses) or a weekly regimen (600 IU/kg x 4 doses) of subcutaneous Epoetin alfa beginning either 2 or 3 weeks before surgery, respectively. Although all Epoetin alfa regimens were effective at accelerating erythropoiesis and increasing red blood cell production, the weekly regimen was the most patient friendly, cost effective regimen for treating preoperative anemia and minimizing patient risk of allogeneic blood transfusion.

Topics: Anemia; Blood Transfusion; Elective Surgical Procedures; Epoetin Alfa; Erythropoiesis; Erythropoietin; Hematinics; Humans; Intraoperative Complications; Multicenter Studies as Topic; Postoperative Complications; Recombinant Proteins; Safety

Topics: Anemia; Blood Loss, Surgical; Blood Transfusion, Autologous; Cost-Benefit Analysis; Erythropoiesis; Erythropoietin; Hemodilution; Humans; Postoperative Complications

Epoetin alfa is a recombinant form of erythropoietin, a glycoprotein hormone which stimulates red blood cell production by stimulating the activity of erythroid progenitor cells. This review discusses the use of the drug in the management of anaemia in diseases often associated with advancing age [renal failure, cancer, rheumatoid arthritis (RA) and other chronic diseases, and the myelodysplastic syndromes (MDS)] and in surgical patients. Intravenous and subcutaneous therapy with epoetin alfa raises haematocrit and haemoglobin levels, and reduces transfusion requirements, in anaemic patients with end-stage renal failure undergoing haemodialysis or peritoneal dialysis. The drug is also effective in the correction of anaemia in patients with chronic renal failure not yet requiring dialysis and does not appear to affect renal haemodynamics adversely or to precipitate the onset of end-stage renal failure. Response rates of 32 to 82% with epoetin alfa therapy have been reported in patients with anaemia associated with cancer or cytotoxic chemotherapy. Limited data in patients with anaemia associated with RA show correction of anaemia after epoetin alfa treatment. Response rates to the drug of 0 to 56% have been noted in patients with MDS. Epoetin alfa also reduces anaemia, increases the capacity for autologous blood donation and reduces the need for allogeneic blood transfusion in patients scheduled to undergo surgery. Hypertension occurs in 30 to 35% of patients with end-stage renal failure who receive epoetin alfa, but this can be managed successfully with correction of fluid status and antihypertensive medication where necessary, and is minimised by avoiding rapid increases in haematocrit. Although vascular access thrombosis has not been conclusively linked to therapy with the drug, increased heparinisation may be required when it is administered to patients on haemodialysis. Epoetin alfa does not appear to exert any direct cerebrovascular adverse effects. Thus, epoetin alfa is a well established and effective therapy for the management of anaemia associated with renal failure. It also improves haematocrit and quality of life in patients with anaemia associated with cancer or chemotherapy. Epoetin alfa increases the capacity for blood donation and reduces the decrease in haematocrit seen in patients donating autologous blood prior to surgery. It also reduces, but may not eliminate, the need for allogeneic blood transfusion.(ABSTRACT TRUNCATED AT 400 WORDS)

Topics: Adolescent; Adult; Aged; Anemia; Chronic Disease; Erythropoietin; Humans; Kidney Failure, Chronic; Middle Aged; Postoperative Complications; Recombinant Proteins

Erythropoietin is the primary growth factor for red blood cells. A glycoprotein hormone synthesized by the kidneys, erythropoietin serves to increase red blood cell production in response to tissue hypoxia. It exerts its effect by increasing the numbers of erythroid progenitor cells in the bone marrow, and by increasing the rate at which their development is accomplished. With the introduction of recombinant erythropoietin in 1987, an important pharmacological agent became available for the manipulation of erythropoiesis. While used primarily for the treatment of the anemia of renal failure, recombinant erythropoietin has also shown usefulness in treating other types of anemias in which the endogenous erythropoietin response is insufficient. Perioperative use of the drug grew as a natural extension of this, and erythropoietin has been applied to correct preoperative anemia, augment autologous blood donation, and improve postoperative red cell recovery. Analysis of these perioperative clinical studies reveals success in these areas, but it also reveals that closer attention to the physiology of the natural response, and to the pharmacology of the recombinant product, might significantly improve results. Such an improvement in efficacy is both desirable and necessary when use of the drug is viewed in the setting of today's changing health care environment. By optimizing dosing schedules and targeting the drug to those most at risk for red cell transfusion, recombinant erythropoietin will likely become an important tool in efforts to achieve the elusive goal of bloodless cardiac surgery.

Topics: Amino Acid Sequence; Anemia; Animals; Blood Transfusion, Autologous; Cardiac Surgical Procedures; Erythropoietin; Humans; Molecular Sequence Data; Postoperative Complications; Preoperative Care; Protein Structure, Secondary; Protein Structure, Tertiary; Recombinant Proteins

A case of posttransplant erythrocytosis in a 51-year-old diabetic man is described. This problem, which can occur in 5 to 15% of renal transplant patients, can result from a contracted plasma volume (diuretics, pressure natriuresis, or glycosuria) or from a true elevation in red blood cell mass. Once the diagnosis of true erythrocytosis is made by a radiolabeled red blood cell mass study, secondary causes such as hypoxia, liver disease, polycythemia rubra vera, renal artery stenosis, and cystic kidney disease should be excluded. Posttransplant erythrocytosis has only been observed in renal transplant recipients and appears to be more frequent with cyclosporine compared with azathioprine therapy. An inappropriately high level of erythropoietin has been described in some, but not all patients, suggesting stimulation of erythropoietin production as the mechanism. Posttransplant erythrocytosis can be associated with an increased incidence of thrombotic events. The presence of this potential complication has prompted intervention to maintain the hematocrit below 50 to 55%. Measures such as discontinuation of diuretics as well as better control of blood pressure and plasma glucose should be used to facilitate the correction of extracellular volume contraction. Phlebotomy has been the most accepted intervention to intermittently lower the hematocrit when needed, but this can lead to iron deficiency. Newer therapeutic modalities are now being used to treat the problem medically. Theophylline, which reduces adenosine-mediated erythropoietin synthesis, is effective but may be associated with side effects.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Blood Volume; Bloodletting; Combined Modality Therapy; Cyclosporine; Diabetic Nephropathies; Diuretics; Erythrocyte Volume; Erythropoietin; Feedback; Humans; Iron Deficiencies; Kidney Transplantation; Male; Middle Aged; Polycythemia; Postoperative Complications; Theophylline

Topics: Adult; Aged; Anemia; Cardiac Surgical Procedures; Erythrocytes; Erythropoietin; Extracorporeal Circulation; Female; Hematopoiesis; Humans; Male; Middle Aged; Postoperative Complications; Recombinant Proteins

Moderately increased blood levels of endogenous erythropoietin (Epo) usually induce complete restoration of renal anemia after successful kidney transplantation. With good graft function erythropoiesis is maintained by normal Epo serum levels. Persistent anemia can be related to iron deficiency, low excretory graft function, and high dosage of immunosuppressive agents leading to marrow suppression or nephrotoxicity. Acute early rejection is associated with a fall in serum Epo and abrogation of reticulocytosis. About 15% of recipients fail to exhibit the normal feedback regulation and develop a mostly transient posttransplant erythrocytosis. Both an increased sensitivity of erythrocytic progenitors to Epo and inappropriate Epo secretion by the native kidneys may account for this overshooting reaction.

Topics: Anemia; Erythropoiesis; Erythropoietin; Graft Rejection; Humans; Kidney Failure, Chronic; Kidney Function Tests; Kidney Transplantation; Postoperative Complications

Topics: Abortion, Therapeutic; Amniocentesis; Amnion; Amniotic Fluid; Cytogenetics; Embryonic and Fetal Development; Erythroblastosis, Fetal; Erythropoietin; Female; Fetal Diseases; Glycoproteins; Humans; Immunoglobulins; L-Lactate Dehydrogenase; Methods; Pharmaceutical Preparations; Placenta Diseases; Placental Lactogen; Postoperative Complications; Pregnancy; Prostaglandins; Punctures; Radiography; Steroids; Vasoconstrictor Agents

Erectile dysfunction significantly impacts quality of life for men undergoing radical prostatectomy for prostate cancer. Erythropoietin is a promising neurotrophic factor for neurogenic erectile dysfunction based on preclinical and retrospective data.. ERECT (NCT00737893) is a phase 2, double-blinded, randomized, placebo-controlled trial (July 2017-December 2019) evaluating the impact of perioperative erythropoietin on recovery of erectile function and other patient-reported, health-related quality of life outcomes after bilateral nerve-sparing radical prostatectomy (3, 6, 9, and 12 months). Erythropoietin (20,000 units) or saline placebo was injected subcutaneously the day before, day of, and day after surgery for 3 total doses.. Of 63 patients assessed for eligibility, 56 patients were randomized. Arms (29 erythropoietin, 27 placebo) were well balanced (89.3% robotic, median age 55.5 years). International Index of Erectile Function-Erectile Function Domain (IIEF-EF) scores increased from median 12.5 at 3 months to 24.5 at 12 months. Median 2-week serum hemoglobin was higher for the erythropoietin arm compared to placebo (14.7 vs 13.6, p=0.02). There was no statistically significant difference in IIEF-EF scores at 6 months comparing erythropoietin to placebo (p=0.50) or at other time points (mixed model regression coefficient: -1.7, 95% CI -6.1-2.7, p=0.45). Excellent nerve-sparing rating (10/10) was associated with improved IIEF-EF recovery (+5.2, p=0.022). Other patient-reported, health-related quality of life domains as well as oncologic outcome and complications were similar between arms during followup.. In the context of brief perioperative dosing, erythropoietin did not improve recovery of erectile function for men undergoing radical prostatectomy for prostate cancer compared to placebo. Further research to identify effective adjuncts to improve health-related quality of life for these men is needed.

Topics: Double-Blind Method; Erectile Dysfunction; Erythropoietin; Humans; Male; Middle Aged; Postoperative Complications; Prospective Studies; Prostatectomy; Prostatic Neoplasms; Quality of Life; Recovery of Function; Treatment Outcome

BACKGROUND Lung injury after cardiopulmonary bypass (CPB) is a serious postoperative complication and can affect the postoperative recovery. The purpose of this study was to explore whether erythropoietin (EPO) has an effect on lung injury caused by CPB. MATERIAL AND METHODS Sixty patients who received the CPB were randomly divided into a saline group and the EPO group. All the patients received saline or EPO preoperatively, respectively. The ventilation function, including dynamic compliance, peak airway pressure, and plateau pressure, were recorded. The level of tumor necrosis factor (TNF)-alpha, interleukin (IL)-1ß, and IL-10 in serum and arterial blood gas were analyzed. The mechanical ventilation time in the intensive care unit (ICU), the length of time spent in the ICU, the time from operation to discharge, and the total time of hospitalization were recorded. Adverse events in the ICU were monitored and recorded. RESULTS EPO significantly decreased the level of TNF-alpha and IL-1ß, but increased the level of IL-10 after CPB. EPO significantly improved pulmonary ventilated function and gas exchange function after CPB. EPO significantly shortened the mechanical ventilation time and stay in the ICU. CONCLUSIONS Preoperative EPO injection reduced lung injury and promoted lung function in patients who underwent CPB. The protection effect of EPO may be associated with inhibition of inflammatory response.

Topics: Adult; Aged; Cardiac Surgical Procedures; Cardiopulmonary Bypass; China; Cytokines; Erythropoietin; Female; Humans; Inflammation Mediators; Interleukin-1beta; Lung; Lung Injury; Male; Middle Aged; Postoperative Complications; Postoperative Period; Respiration, Artificial; Thoracic Surgical Procedures; Tumor Necrosis Factor-alpha

In orthopedic surgery, a patient blood management program (PBM) has been proposed to reduce blood transfusion. The aim of this observational study was to assess, within a PBM, the specific efficacy of preoperative erythropoietin (EPO).. In a single hospital, 723 patients undergoing elective primary hip or knee arthroplasty were prospectively studied. The PBM included EPO if preoperative hemoglobin was lower than 13 g/dL, intraoperative administration of tranexamic acid, use of recommended transfusion thresholds, and postoperative infusion of iron. Blood transfusion and hemoglobin were noted until discharge. Major thromboembolic or cardiovascular events were assessed during admission and 1 month after discharge.. Transfusion was noted in 2.5% patients with EPO. Transfusion rate was higher in patient for whom EPO was not indicated (13.6% transfusion rate; odds ratio [OR], 13.7; 95% confidence interval [CI], 2.6-66; p = 10. Within a PBM, preoperative treatment of anemia with EPO decreased both the rate of blood transfusion and postoperative anemia. Further studies are necessary to confirm these results.

Topics: Aged; Anemia; Arthroplasty, Replacement, Hip; Arthroplasty, Replacement, Knee; Blood Transfusion; Erythropoietin; Female; Humans; Iron; Male; Middle Aged; Postoperative Complications; Preoperative Period; Prospective Studies; Tranexamic Acid

Erythropoietin receptors have been localized to human penile tissue and periprostatic neurovascular bundles. ERECT is a placebo-controlled, phase 2, randomized trial assessing the effect of erythropoietin on recovery of erectile function for men undergoing radical prostatectomy for prostate cancer.

Topics: Clinical Trials, Phase II as Topic; Erectile Dysfunction; Erythropoietin; Humans; Male; Postoperative Complications; Prostatectomy; Prostatic Neoplasms; Randomized Controlled Trials as Topic; Recovery of Function

OBJECTIVE Posttraumatic hydrocephalus (PTH) affects 11.9%-36% of patients undergoing decompressive craniectomy (DC) and is an important cause of morbidity after traumatic brain injury (TBI). Early diagnosis and treatment of PTH can prevent further neurological compromise in patients who are recovering from TBI. There is limited data on predictors of shunting for PTH after DC for TBI. METHODS Prospectively collected data from the erythropoietin severe TBI randomized controlled trial were studied. Demographic, clinical, and imaging data were analyzed for enrolled patients who underwent a DC. All head CT scans during admission were reviewed and assessed for PTH by the Gudeman criteria or the modified Frontal Horn Index ≥ 33%. The presence of subdural hygromas was categorized as unilateral/bilateral hemispheric or interhemispheric. Using L1-regularized logistic regression to select variables, a multiple logistic regression model was created with ventriculoperitoneal shunting as the binary outcome. Statistical significance was set at p < 0.05. RESULTS A total of 60 patients who underwent DC were studied. Fifteen patients (25%) underwent placement of a ventriculoperitoneal shunt for PTH. The majority of patients underwent unilateral decompressive hemicraniectomy (n = 46, 77%). Seven patients (12%) underwent bifrontal DC. Unilateral and bilateral hemispheric hygromas were noted in 31 (52%) and 7 (11%) patients, respectively. Interhemispheric hygromas were observed in 19 patients (32%). The mean duration from injury to first CT scan showing hemispheric subdural hygroma and interhemispheric hygroma was 7.9 ± 6.5 days and 14.9 ± 11.7 days, respectively. The median duration from injury to shunt placement was 43.7 days. Multivariate analysis showed that the presence of interhemispheric hygroma (OR 63.6, p = 0.001) and younger age (OR 0.78, p = 0.009) were significantly associated with the need for a shunt after DC. CONCLUSIONS The presence of interhemispheric subdural hygromas and younger age were associated with shunt-dependent hydrocephalus after DC in patients with severe TBI.

Topics: Adult; Age Factors; Blood Transfusion; Brain Injuries, Traumatic; Cerebrospinal Fluid Shunts; Decompressive Craniectomy; Erythropoietin; Female; Humans; Hydrocephalus; Male; Postoperative Complications

To study the effects of intermittent whole-body hypoxic preconditioning on patients with carotid artery stenosis.. Fifty patients with carotid artery stenosis were selected and randomly divided into a hypoxic intervention group (HIG) and a control group (CG). Both groups were treated with a hypoxic respiration device for 7 days (HIG: 18% oxygen, CG: 21% oxygen). Venous blood samples were taken preoperatively and postoperatively. The subjects' vital signs were recorded during and after the intervention. After the completion of the trial, the concentrations of hemoglobin, hypoxia inducible factor-1α, erythropoietin, vascular endothelial growth factor, neuron-specific enolase, S100β protein, brain-derived neurotrophic factor, serum aspartate transaminase, serum alanine aminotransferase, serum creatinine, and blood urea nitrogen were measured in the previously selected blood samples.. During the intervention, the vital signs of the HIG were significantly different from those of the CG (P < 0.05). In the HIG, postoperative concentrations of hemoglobin, erythropoietin, hypoxia inducible factor-1α, and vascular endothelial growth factor were significantly more than the preoperative values (P < 0.05). In the CG, postoperative concentrations of neuron-specific enolase and S100β protein were more than the preoperative values (P < 0.05). The concentrations of brain-derived neurotrophic factor, serum aspartate transaminase, serum alanine aminotransferase, serum creatinine, and blood urea nitrogen showed no significant differences between their preoperative and postoperative values in either the HIG or the CG (P > 0.05).. Intermittent hypoxic preconditioning can change the vital signs and hematologic indexes of patients with carotid artery stenosis without causing new postoperative complications or organ damage.

Topics: Alanine Transaminase; Aspartate Aminotransferases; Biomarkers; Blood Urea Nitrogen; Brain-Derived Neurotrophic Factor; Carotid Stenosis; Creatinine; Equipment Design; Erythropoietin; Female; Hemoglobins; Humans; Hypoxia-Inducible Factor 1, alpha Subunit; Hypoxia-Ischemia, Brain; Intraoperative Complications; Ischemic Preconditioning; Male; Middle Aged; Oxygen; Phosphopyruvate Hydratase; Postoperative Complications; Preoperative Care; Vascular Endothelial Growth Factor A

We conducted a prospective single-blind randomized study to assess whether a single 80,000 IU dose of human recombinant erythropoietin (HRE), given just 2 days before cardiac surgery, could be effective in reducing perioperative allogeneic red blood cell transfusion (aRBCt).. Six-hundred patients presenting with preoperative hemoglobin (Hb) level of not more than 14.5 g/dL were randomly assigned to either HRE or control. The primary endpoint was the incidence of perioperative aRBCt. The secondary endpoints were mortality and the incidence of adverse events in the first 45 days after surgery, Hb level on Postoperative Day 4, and number of units of RBC transfusions in the first 4 days after surgery.. A total of 17% (HRE) versus 39% (control) required transfusion (relative risk, 0.436; p<0.0005). After baseline Hb was controlled for, there was no difference in the incidence of aRBCt between HRE (0%) and control (3.5%) among the patients with baseline Hb of 13.0 g/dL or more, which included the nonanemic fraction of the study population. The mean (range) Hb level on Postoperative Day 4 was 10.2 (9.9-10.6) g/dL (HRE) versus 8.7 (8.5-9.2) g/dL (control; p<0.0005). The distribution of number of units transfused was shifted toward fewer units in HRE (p<0.0005). The all-cause mortality at 45 days was 3.00% (HRE) versus 3.33% (control). The 45-day adverse event rate was 4.33% (HRE) versus 5.67% (control; both p=NS).. In anemic patients (Hb<13 g/dL), a single high dose of HRE administered 2 days before cardiac surgery is effective in reducing the incidence of aRBCt without increasing adverse events.

Topics: Adult; Aged; Aged, 80 and over; Cardiac Surgical Procedures; Erythrocyte Transfusion; Erythropoietin; Humans; Incidence; Middle Aged; Perioperative Care; Postoperative Complications; Time Factors

The study aimed to analyse the feasibility and efficacy of administration of a single intravenous iron infusion (IVI) in the preoperative optimization of colorectal cancer patients with anaemia.. Twenty patients were recruited at least 14 days before the planned date of surgery. A single 1000 mg dose of ferric carboxymaltose (Ferinject) was administered as an outpatient procedure. Blood samples were taken at recruitment prior to drug administration (REC), on the day of surgery prior to any intervention (DOS) and on the first postoperative day. Allogeneic red blood cell transfusions (ARBT) and outcomes were recorded from recruitment throughout the study period.. There was a significant median rise in haemoglobin levels (Hb) from REC to DOS of 1.8 g/dl [interquartile range (IQR) 0.75-2.45, P < 0.001] for the entire cohort. Two patients received ARBT preoperatively, and for those not transfused preoperatively (n = 18), this incremental Hb rise remained significant (P < 0.001, median 1.65 g/dl, IQR 0.5-2.3). Of these patients, those who responded to IVI had higher erythropoietin (EPO) levels at recruitment (P < 0.01) and lower recruitment Hb values, transferrin-saturation (TSAT) and C-reactive protein (CRP) levels (P < 0.05). REC Hb (Rs = -0.62, P < 0.01), REC TSAT levels (Rs = -0.67, P < 0.01) and REC EPO (Rs = 0.69, P < 0.01) correlated with the magnitude of treatment change in Hb levels. Five patients received ARBT until the fourth postoperative day, which was significantly fewer than predicted (P < 0.05).. IVI can be administered preoperatively in the outpatient clinic to colorectal cancer patients with anaemia, with associated reduction in ARBT use and increase in Hb levels.

Topics: Adenocarcinoma; Aged; Aged, 80 and over; Anemia; C-Reactive Protein; Colorectal Neoplasms; Erythrocyte Transfusion; Erythropoietin; Feasibility Studies; Female; Ferric Compounds; Hemoglobins; Humans; Infusions, Intravenous; Length of Stay; Male; Maltose; Middle Aged; Pilot Projects; Postoperative Complications; Preoperative Care; Transferrins

We conducted a randomized study analyzing the impact of darbepoetin alfa (DA) administration with or without intravenous (i.v.) iron on erythroid recovery after autologous hematopoietic cell transplantation (HCT). Patients were randomized between no DA (Arm 1), DA 300 μg every 2 weeks starting on Day 28 after HCT (Arm 2), or DA plus i.v. iron 200 mg on Days 28, 42, and 56 (Arm 3). The proportion achieving complete hemoglobin (Hb) response within 18 weeks (primary end point) was 21% in Arm 1 (n = 24), 79% in Arm 2 (n = 25), and 100% in Arm 3 (n = 23; P < 0.0001). Erythropoietic response was shown to be significantly higher in Arm 3 (n = 46) than in Arm 2 (n = 50; P = 0.008), resulting in lower DA use, reduced drug costs, and improved quality of life scores, but the effect on transfusions was not significant. In multivariate analysis, DA administration (P < 0.0001), i.v. iron administration (P = 0.0010), high baseline Hb (P < 0.0001), and low baseline creatinine (P = 0.0458) were independently associated with faster achievement of complete Hb response. In conclusion, DA is highly effective to ensure full erythroid reconstitution after autologous HCT when started on Day 28 post-transplant. I.v. iron sucrose further improves erythroid recovery.

Topics: Aged; Anemia; Blood Transfusion; Combined Modality Therapy; Darbepoetin alfa; Drug Therapy, Combination; Erythropoiesis; Erythropoietin; Female; Ferric Compounds; Ferric Oxide, Saccharated; Glucaric Acid; Hematopoietic Stem Cell Transplantation; Humans; Infusions, Intravenous; Injections, Subcutaneous; Lymphoma; Male; Middle Aged; Multiple Myeloma; Postoperative Complications; Quality of Life; Transferrin; Transplantation Conditioning; Transplantation, Autologous

Recombinant human erythropoietin (EPO) is known to provide organ protection against ischemia-reperfusion injury through its pleiotropic properties. The aim of this single-site, randomized, case-controlled, and double-blind study was to investigate the effect of pre-emptive EPO administration on the incidence of postoperative acute kidney injury (AKI) in patients with risk factors for AKI undergoing complex valvular heart surgery.. We studied ninety-eight patients with preoperative risk factors for AKI. The patients were randomly allocated to either the EPO group (n = 49) or the control group (n = 49). The EPO group received 300 IU/kg of EPO intravenously after anesthetic induction. The control group received an equivalent volume of normal saline. AKI was defined as an increase in serum creatinine >0.3 mg/dl or >50% from baseline. Biomarkers of renal injury were serially measured until five days postoperatively.. Patient characteristics and operative data, including the duration of cardiopulmonary bypass, were similar between the two groups. Incidence of postoperative AKI (32.7% versus 34.7%, P = 0.831) and biomarkers of renal injury including cystatin C and neutrophil gelatinase-associated lipocalin showed no significant differences between the groups. The postoperative increase in interleukin-6 and myeloperoxidase was similar between the groups. None of the patients developed adverse complications related to EPO administration, including thromboembolic events, throughout the study period.. Intravenous administration of 300 IU/kg of EPO did not provide renal protection in patients who are at increased risk of developing AKI after undergoing complex valvular heart surgery.. Clinical Trial.gov, NCT01758861.

Topics: Acute Kidney Injury; Biomarkers; Cardiopulmonary Bypass; Case-Control Studies; Double-Blind Method; Epoetin Alfa; Erythropoietin; Female; Heart Valve Diseases; Hematinics; Hematocrit; Humans; Incidence; Kidney Function Tests; Male; Middle Aged; Postoperative Complications; Recombinant Proteins; Risk Factors; Treatment Outcome

To determine the effect of recombinant erythropoietin on serum oxidants and the viability of ischemic ovaries after detorsion.. A non-randomized single-blind clinical trial was conducted from December 2009 to January 2011 in a University Teaching Hospital affiliated with the School of Medicine, Tabriz University of Medical Sciences. Surgery was carried out on 40 patients, aged 18-35 years, with signs and symptoms of ovarian torsion. The patients were divided into two equal groups: group 1 received recombinant erythropoietin 150 IU/kg subcutaneously during the operation and 72 h after detorsion, and group 2 received no medication. Blood samples were taken before and 72 h after detorsion to determine the plasma levels of malondialdehyde, xanthine oxidase, glutathione, superoxide dismutase, nitric oxide, and total antioxidants. In both groups, the arterial and venous blood supply of the ovary and arterial blood flow resistance were evaluated before surgery and 72 h after detorsion of the ovary. The main outcome measures were improving ovarian blood flow and reducing oxidative damage. SPSS 17.0 was used for statistical analyses.. The levels of malondialdehyde, glutathione, superoxide dismutase, nitric oxide, and total antioxidants 72 h after detorsion were significantly different between the interventional and non-interventional groups (p<0.001). There was no significant difference in the levels of xanthine oxidase (p=0.13). The difference between groups in the blood flow of the ovary 72 h after surgery was not statistically significant (p=0.61).. Recombinant erythropoietin was effective in reducing the oxidative damage of ovarian torsion.

Topics: Adolescent; Adult; Erythropoietin; Female; Humans; Ovarian Diseases; Oxidative Stress; Postoperative Complications; Recombinant Proteins; Reperfusion Injury; Torsion Abnormality; Young Adult

Experimentally, erythropoietin (EPO) has nephroprotective as well as immunomodulatory properties when administered after ischemic renal injury. We tested the hypothesis that different doses of recombinant human EPO administered to patients after cardiac surgery would minimize kidney lesions and the systemic inflammatory response, thereby decreasing acute kidney injury (AKI) incidence.. In this double-blinded randomized control study, 80 patients admitted to the ICU post-cardiac surgery were randomized by computer to receive intravenously isotonic saline (n = 40) versus α-Epoetin (n = 40): either 40000 IU (n = 20) or 20000 IU (n = 20). The study lasted one year. The primary outcome was the change in urinary NGAL concentration from baseline and 48 h after EPO injection. Creatinine, cystatine C and urinary NGAL levels were measured on the day of randomization and 2-4 days after EPO injection. To assess acute inflammatory response, serum cytokines (IL6 and IL8) were measured at randomization and four days after r-HuEPO injection. Patients and care-takers were blinded for the assignment.. No patient was excluded after randomization. Patient groups did not differ in terms of age, gender, comorbidities and renal function at randomization. The rate of AKI assessed by AKIN criteria was 22.5% in our population. EPO treatment did not significantly modify the difference in uNGAl between 48 hours and randomization compared to placebo [2.5 ng/ml (-17.3; 22.5) vs 0.7 ng/ml (-31.77; 25.15), p = 0.77] and the incidence of AKI was similar. Inflammatory cytokines levels were not influenced by EPO treatment. Mortality and hospital stays were similar between the groups and no adverse event was recorded.. In this randomized-controlled trial, α-Epoetin administrated after cardiac surgery, although safe, demonstrated neither nephroprotective nor anti-inflammatory properties.. NCT00676234.

Topics: Aged; Aged, 80 and over; Biomarkers; Cardiac Surgical Procedures; Double-Blind Method; Epoetin Alfa; Erythropoietin; Female; Follow-Up Studies; Humans; Inflammation; Inflammation Mediators; Kidney; Male; Middle Aged; Pilot Projects; Postoperative Complications; Recombinant Proteins; Treatment Outcome

Anemia is common during anticancer treatment. This study aimed to evaluate the response and safety of treatment with epoetin-beta (EB) in patients with neoadjuvant therapy prior to primary digestive tract tumor surgery.. In this open-label, single-arm study, patients (n = 22) with hemoglobin (Hb) levels below 11 g/dl who received epoetin-beta 450 IU/kg (30,000 IU) weekly until the hemoglobin level reached 12 g/dl.. After treatment with EB, a mean absolute increment of 2.6 g/dl was attained. The mean hemoglobin values during the study were pretreatment 10.1 g/dl, half-way through treatment 12.3 g/dl, 4 weeks after concomitant radiochemotherapy 12.7 g/dl, the week prior to surgery 12.5 g/dl, and after surgery 10.9 g/dl. No patient required transfusion before or after surgery. The probability or risk of postoperative complications was 27.3%, and included one rectovaginal fistula, one parastomal hernia, one case of ileus and two surgical wound infections. In this series, downstaging was observed in 81.8% of patients, and downsizing in 90.9%. Most interestingly, histopathological complete response rate was achieved by 18.2%.. Epoetin-beta (EB) treatment in our series of patients with digestive malignancies subjected to neoadjuvant radiochemotherapy proved effective and safe, avoiding the need for transfusion during surgery.

Topics: Aged; Anemia; Cohort Studies; Combined Modality Therapy; Erythropoietin; Female; Gastrointestinal Neoplasms; Hematinics; Hemoglobins; Humans; Male; Middle Aged; Neoadjuvant Therapy; Postoperative Complications; Prospective Studies; Recombinant Proteins; Treatment Outcome

Cardiac surgery and cardiopulmonary bypass (CPB) induce an inflammatory reaction that may lead to tissue injury. Experimental studies suggest that recombinant human erythropoietin (EPO) independent of its erythropoietic effect may be used clinically as an anti-inflammatory drug. This study tested the hypothesis that 2 large doses of EPO administered shortly before CPB ameliorate the systemic inflammatory response to CPB.. A prospective, double-blind, placebo-controlled and randomized study at a single tertiary care hospital.. Patients scheduled for coronary artery bypass graft surgery with CPB.. EPO (epoetin alfa, 500 IU/kg intravenously, n = 22) or placebo (n = 21) was administered 12 to 18 hours preoperatively and again at the induction of anesthesia.. CPB in both groups greatly increased plasma concentrations of tumor necrosis factor alpha (TNF-alpha), interleukin (IL)-1beta, IL-1beta receptor antagonist, IL-6, IL-10, and N-terminal probrain natriuretic peptide (NT-proBNP). Compared with placebo, EPO at day 3 after CPB augmented the TNF-alpha response (p < 0.05) and at 2 hours after CPB increased NT-proBNP (p < 0.05). Also, EPO tended to enhance the CPB-induced increase in IL-1beta receptor antagonist (p = 0.057). Otherwise, EPO had no effect on pro- and antiinflammatory mediators compared with placebo.. Two large doses of EPO given shortly before CPB do not reduce perioperative release of inflammatory cytokines. In contrast, EPO may augment the TNF-alpha and NT-proBNP response. Although the long-term clinical impact remains unknown, the findings do not support use of EPO as an anti-inflammatory drug in patients undergoing cardiac surgery.

Topics: Aged; Cardiac Surgical Procedures; Double-Blind Method; Erythropoietin; Female; Humans; Inflammation Mediators; Male; Middle Aged; Postoperative Complications; Preoperative Care; Prospective Studies; Recombinant Proteins; Time Factors

Depending on the specific definition, acute kidney injury (AKI) occurs in 7-40% of patients undergoing cardiac surgery. Even small changes in serum creatinine (SCr) levels are associated with increased mortality after cardiac surgery. However, there are no current methods for preventing AKI after cardiac surgery. Erythropoietin (EPO) has been shown to elicit tissue-protective effects in various experimental models. In this pilot trial, we evaluated the effectiveness of EPO in the prevention of AKI after coronary artery bypass grafting (CABG).. 71 patients scheduled for elective CABG randomly received either 300 U/kg of EPO or saline intravenously before surgery. AKI was defined as a 50% increase in SCr levels over baseline within the first 5 postoperative days. Estimated glomerular filtration rate (eGFR) was calculated from the Cockcroft-Gault equation.. Of 71 patients, 13 developed postoperative AKI: 3 of the 36 patients in the EPO group (8%) and 10 of the 35 patients in the placebo group (29%; p = 0.035). The increase in postoperative SCr concentration and the decline in postoperative eGFR were significantly lower in the EPO group than in the placebo group.. In our small, pilot trial, prophylactic administration of EPO prevents AKI and improves postoperative renal function. These data are preliminary and require confirmation in a larger clinical trial.

Topics: Acute Kidney Injury; Aged; Coronary Artery Bypass; Double-Blind Method; Erythropoietin; Female; Humans; Incidence; Male; Middle Aged; Pilot Projects; Postoperative Complications; Prospective Studies

Preoperative anaemia is a major risk factor for allogeneic blood transfusion (ABT) in patients undergoing hip fracture repair. We investigated the efficacy of preoperative recombinant human erythropoietin (rHuEPO) administration for reducing ABT requirements in a series of consecutive hip fracture patients presenting with haemoglobin (Hb) between 10 g/dl and 13 g/dl.. The blood conservation protocol consisted of the application of a restrictive transfusion trigger (Hb < 8 g/dl) and the perioperative administration of intravenous iron sucrose (3 x 200 mg/48 h) (group 1, n = 115). Additionally, some patients received preoperative rHuEPO (40 000 IU sc) on admission to the orthopaedic ward (group 2, n = 81).. Overall, 103 of 196 patients (52.5%) received at least one ABT unit (2.1 +/- 1.0 U/patient). However, there were significant differences in perioperative ABT rates between groups (60% vs. 42%, for groups 1 and 2, respectively; P = 0.013). Postoperative Hb on postoperative days 7 and 30 was higher in group 2 than in group 1. In addition, in group 2, Hb levels were higher on postoperative day 30 than on admission (12.7 +/- 1.0 g/dl vs. 11.9 +/- 0.8 g/dl, respectively; P = 0.030). Administration of rHuEPO did not increase postoperative complications or 30-day mortality rate. Only three mild intravenous iron adverse effects were witnessed.. In anaemic hip fracture patients managed with perioperative intravenous iron and restrictive transfusion protocol, preoperative administration of rHuEPO is associated with reduced ABT requirements. However, appropriate training, education and awareness are needed to avoid protocol violations and to limit further exposure to ABT and ABT-related risks.

Topics: Aged; Aged, 80 and over; Ascorbic Acid; Blood Loss, Surgical; Blood Transfusion; Epoetin Alfa; Erythropoietin; Female; Ferric Compounds; Ferric Oxide, Saccharated; Folic Acid; Fracture Fixation, Internal; Glucaric Acid; Guideline Adherence; Hip Fractures; Hospitals, University; Humans; Male; Postoperative Complications; Premedication; Prospective Studies; Recombinant Proteins; Retrospective Studies; Vitamin B 12

Neurocognitive dysfunction complicates coronary artery bypass surgery. Erythropoietin may be neuroprotective. We sought to determine whether human recombinant erythropoietin would reduce the incidence of neurocognitive dysfunction after surgery.. We randomly assigned 32 elective first-time coronary artery bypass graft patients to receive placebo or 375 U/kg, 750 U/kg, or 1500 U/kg of recombinant human erythropoietin divided in 3 daily doses, starting the day before surgery. Primary outcomes were feasibility and safety, and secondary outcomes were neurocognitive dysfunction at discharge and 2 months.. All subjects were male, mean age 60 years (range 46 to 73). No significant differences were found in pump time, cross-clamp time, or hospital length of stay. Mortality and pure red cell aplasia were not observed. One patient in the 375 U/kg group had ST changes compatible with myocardial injury immediately postoperative, but no other thrombotic complications were observed. Neurocognitive dysfunction occurred in 21/32 (66%) of patients at discharge and 5/32 (16%) at 2 months. Neurocognitive dysfunction at discharge by group was: placebo 6/8 (75%), 375 U/kg 4/8 (50%), 750 U/kg 6/8 (75%), and 1500 U/kg 5/8 (63%). Neurocognitive dysfunction at 2 months by group was: placebo 3/8 (38%), 375 U/kg 1/8 (13%), 750 U/kg 1/8 (13%), and 1500 U/kg 0/8 (0%). Neurocognitive dysfunction at 2 months for erythropoietin at any dose was 2/24 (8.3%) versus 3/8 (38%) for placebo (P=0.085).. This study demonstrates feasibility and safety for the use of human recombinant erythropoietin as a neuroprotectant in coronary artery bypass graft surgery. A trend in the reduction of neurocognitive dysfunction at 2 months was associated with erythropoietin use. A multicenter randomized controlled trial is warranted.

Topics: Aged; Cognition Disorders; Coronary Artery Bypass; Double-Blind Method; Erythropoietin; Feasibility Studies; Follow-Up Studies; Humans; Male; Middle Aged; Neuroprotective Agents; Postoperative Complications; Recombinant Proteins

Craniosynostotic correction typically performed around infant physiologic nadir of hemoglobin (approximately 3-6 months of age) is associated with high transfusion rates of packed red blood cells and other blood products. As a blood conserving strategy, we studied the use of 1) recombinant human erythropoietin or Procrit (to optimize preoperative hematocrit) and 2) Cell Saver (to recycle the slow, constant ooze of blood during the prolonged case).. UCLA Patients with craniosynostosis from 2003-2005 were divided into 1) the study group (Procrit and Cell Saver) or 2) the control group (n = 79). The study group 1) received recombinant human erythropoietin at 3 weeks, 2 weeks, and 1 week preoperatively and 2) used Cell Saver intraoperatively. Outcomes were based on morbidities and transfusion rate comparisons.. The 2 groups were comparable with regards to age (5.66 and 5.71 months), and operative times (3.11 vs 2.59 hours). In the study group there was a marked increase in preoperative hematocrit (56.2%). The study group had significantly lower transfusions rates (5% vs 100% control group) and lower volumes transfused than in the control group (0.05 pediatric units vs 1.74 pediatric units). Additionally, of the 80% of patients in the study group who received Cell Saver blood at the end of the case, approximately 31% would have needed a transfusion if the recycled blood were unavailable.. Our data showed that for elective craniosynostotic correction, successful blood conserving dual therapy with Procrit and Cell Saver might be used to decrease transfusion rates and the need for any blood products.

Topics: Blood Loss, Surgical; Blood Transfusion; Blood Transfusion, Autologous; Craniosynostoses; Craniotomy; Elective Surgical Procedures; Epoetin Alfa; Erythropoietin; Hematinics; Hematocrit; Hemoglobins; Humans; Infant; Injections, Subcutaneous; Intraoperative Care; Plastic Surgery Procedures; Postoperative Complications; Premedication; Recombinant Proteins; Time Factors; Treatment Outcome

This randomized trial assessed the effect of recombinant human erythropoietin (EPO) vs preoperative autologous donation (PAD) on postoperative vigor and handgrip strength in patients undergoing primary total joint arthroplasty. Adults with baseline hemoglobin level of 11 to 14 g/dL received EPO (600 IU/kg once weekly for 4 doses, n = 130) or PAD (n = 121) before primary, unilateral hip or knee arthroplasty. Mean changes in vigor score and handgrip strength from baseline were not significantly different between treatment groups. Multivariate analyses found a significant treatment effect favoring EPO over PAD for vigor, but not for handgrip strength. Patients in the EPO group had higher hemoglobin levels and required fewer transfusions. Both treatments were well tolerated. Additional study is needed to elucidate the influence of blood management strategies on postoperative vigor.

Topics: Activities of Daily Living; Aged; Anemia; Arthroplasty, Replacement, Hip; Arthroplasty, Replacement, Knee; Blood Transfusion, Autologous; Epoetin Alfa; Erythropoietin; Female; Hand Strength; Health Status; Health Status Indicators; Hematinics; Hemoglobins; Humans; Male; Middle Aged; Postoperative Complications; Postoperative Period; Recombinant Proteins

In a previous study we showed that many patients with esophagogastric adenocarcinoma experience anemia during neoadjuvant chemotherapy. We now investigated the role of erythropoietin in managing anemia during neoadjuvant chemotherapy.. Patients with esophagogastric adenocarcinoma who experienced anemia (hemoglobin < 12 g/dL) during neoadjuvant treatment received erythropoietin 10,000 IE subcutaneously three times a week. Primary outcomes were the response to erythropoietin, safety, the need for allogeneic red blood cell transfusion, and the rate of postoperative complications.. Between April 2003 and December 2004, 24 patients (median age, 62 years) were enrolled. The mean hemoglobin level before chemotherapy was 12.5 g/dL and the mean hemoglobin level before patients received erythropoietin was 11.5 g/dL. One year after involvement in the trial, 4 of 17 analyzable patients were still anemic (hemoglobin level < 12 mg/dL). Twenty-two patients received erythropoietin, and 16 (73%) responded. We could observe a significant increase in hemoglobin concentrations under therapy with erythropoietin to 12.6 g/dL (p < 0.001). Two patients (8%) received allogeneic transfusions; the rate of postoperative complications was 16%. There were no erythropoietin-related adverse events.. Treatment with erythropoietin is effective and well tolerated in patients with esophagogastric adenocarcinoma who experience anemia during neoadjuvant chemotherapy.

Topics: Adenocarcinoma; Aged; Anastomosis, Surgical; Anemia; Antineoplastic Combined Chemotherapy Protocols; Blood Transfusion; Cisplatin; Combined Modality Therapy; Epoetin Alfa; Erythropoietin; Esophageal Neoplasms; Esophagectomy; Esophagogastric Junction; Female; Fluorouracil; Gastrectomy; Hemoglobins; Humans; Leucovorin; Male; Middle Aged; Neoadjuvant Therapy; Organoplatinum Compounds; Oxaliplatin; Paclitaxel; Postoperative Complications; Prospective Studies; Recombinant Proteins; Stomach Neoplasms; Survival Analysis

Unilateral total knee replacement (TKR) results in a substantial blood loss and 30 to 50 percent of patients receive allogeneic blood transfusion (ABT). Therefore, the effectiveness of a restrictive transfusion trigger (hemoglobin [Hb] level < 8 g/dL) plus stimulation of erythropoiesis was evaluated, with or without blood salvage, for reducing ABT in TKR patients.. A series of 139 consecutive of primary TKR patients received perioperative iron sucrose (2 x 200 mg/48 hr, intravenously [IV]), plus preoperative erythropoietin (EPO; 1 x 40.000 UI, sc) if preoperative Hb level was less than 130 g per L (Group A). This protocol was applied to another series of 173 consecutive TKR patients who also received postoperative unwashed shed blood (USB) if preoperative Hb level was less than 130 g per L (Group B). Perioperative clinical and laboratory data were gathered.. No adverse effects of iron sucrose, EPO, or USB administration were witnessed, and only 13 patients received ABT overall (4%). No major differences in perioperative blood counts or iron metabolism variables were observed between groups, but stimulation of erythropoiesis seemed to be more pronounced in those patients receiving EPO (p < 0.05). There were no differences in postoperative complications between groups, but length of hospital stay for patients with a preoperative Hb level of less than 130 g per L was shorter in Group B (p < 0.05).. This blood saving protocol seems to be effective for reducing ABT in TKR patients. Which patients are more likely to benefit from either perioperative iron administration or selective addition of postoperative blood salvage to pharmacologic treatment, however, needs to be further evaluated.

Topics: Aged; Arthroplasty, Replacement, Knee; Blood Loss, Surgical; Blood Transfusion; Erythropoiesis; Erythropoietin; Female; Hemoglobins; Humans; Iron; Length of Stay; Male; Perioperative Care; Postoperative Complications; Recombinant Proteins

Preoperative epoetin-alpha administration is said to have a limited effect in patients with chronic inflammatory diseases such as rheumatoid arthritis (RA), due to lower iron availability. We studied the effects of preoperative epoetin-alpha treatment in orthopedic surgery patients in a daily life setting in which iron supplementation was assured, and compared the effects in RA and non-RA patients.. In an open, naturalistic, randomized controlled trial, 695 orthopedic surgery patients with preoperative hemoglobin (Hb) values of 10-13 g/dL, either with RA (113) or without RA (582), received either preoperative epoetin-alpha treatment added to standard care, or standard care alone. Hb values and transfusions were evaluated from entry into the study until 4-6 weeks after surgery.. Both in RA and non-RA patients, perioperative Hb values were significantly higher and transfusion requirements were significantly lower in epoetin-alpha treated patients than in control patients (p < 0.001). In RA patients, the outcomes regarding Hb values were not significantly or relevantly different from non-RA patients.. Just as with orthopedic patients in general, RA patients benefit from preoperative epoetin-alpha treatment in combination with iron supplementation. We postulate that iron supplementation during epoetin-alpha therapy in RA patients is important for optimal efficacy.

Topics: Aged; Arthritis, Rheumatoid; Arthroplasty, Replacement, Hip; Arthroplasty, Replacement, Knee; Blood Loss, Surgical; Blood Transfusion; Epoetin Alfa; Erythropoietin; Female; Follow-Up Studies; Hemoglobins; Humans; Iron; Male; Middle Aged; Postoperative Complications; Premedication; Recombinant Proteins; Spinal Diseases; Treatment Outcome

Results of treatment of 39 patients, to whom pancreatoduodenal resection was performed for periampullar zone tumour, were analyzed. Anemia, revealed before the operation, had constituted the factor, which trustworthily increased the postoperative complications occurrence risk. Therapeutic course, using recombinant erythropoietins, was conducted for correction of anemia in 7 patients. This had promoted the hemoglobin level raising, the risk of postoperative complications occurrence lowering, but did not influence the intraoperative blood loss severity and perioperative hemotransfusion volume.

Topics: Adenocarcinoma; Adult; Aged; Aged, 80 and over; Anemia; Bile Duct Neoplasms; Digestive System Neoplasms; Drug Administration Schedule; Duodenal Neoplasms; Epoetin Alfa; Erythropoietin; Female; Humans; Male; Middle Aged; Pancreatic Neoplasms; Pancreaticoduodenectomy; Postoperative Complications; Recombinant Proteins; Risk Factors; Treatment Outcome

Preoperative epoetin alfa administration decreases transfusion requirements and may reduce transfusion complications, such as postoperative infection due to immune suppression and thus hospitalization time. This study examined the impact of preoperative epoetin alfa administration on postoperative recovery and infection rate.. In an open randomized controlled multicentre trial in patients undergoing orthopaedic surgery, the effects of preoperative administration of epoetin alfa vs. routine care were compared in six countries. Haemoglobin (Hb) values, transfusions, time to ambulation, time to discharge, infections and safety were evaluated in patients with preoperative Hb concentrations 10-13g dL(-1) (on-treatment population: epoetin n = 460; control n = 235), from study entry until 4-6 weeks after surgery. Outcome was also compared in patients with and without transfusion.. Epoetin-treated patients had higher Hb values from the day of surgery until discharge (P < 0.001) and lower transfusion rates (12% vs. 46%; P < 0.001). Epoetin treatment delivered no significant effect on postoperative recovery (time to ambulation, time to discharge and infection rate). However, the time to ambulation (3.8+/-4.0 vs. 3.1+/-2.2days; P < 0.001)and the time to discharge (12.9+/-6.4 vs. 10.2+/-5.0 days; P < 0.001) was longer in the transfused than in the non-transfused patients. Side-effects in both groups were comparable.. Epoetin alfa increases perioperative Hb concentration in mild-to-moderately anaemic patients and thus reduces transfusion requirements. Patients receiving blood transfusions require a longer hospitalization than non-transfused patients.

Topics: Aged; Anemia; Arthroplasty, Replacement, Hip; Arthroplasty, Replacement, Knee; Blood Transfusion; Epoetin Alfa; Erythropoietin; Europe; Female; Hematinics; Hemoglobins; Humans; Male; Orthopedic Procedures; Postoperative Care; Postoperative Complications; Prospective Studies; Recombinant Proteins; Surgical Wound Infection; Treatment Outcome

Topics: Anemia; Biomarkers; Blood Cell Count; Blood Pressure; Creatinine; Darbepoetin alfa; Drug Administration Schedule; Erythropoietin; Hemoglobins; Humans; Kidney Transplantation; Postoperative Complications; Proteinuria

To observe the effect of rhEPO on postoperative anemia in orthognathic patients.. 31 patients had 500-1200 ml blood loss during orthognathic operation, who were divided into two groups randomly, the experiment group and the control group. The patients in the experiment group received rhEPO 6000IU subcutaneously for 3 times in a week and Ferrost sulfatis Et vitamini-medtech 1 tablet per day via oral administration for 12 days after operation, while the patients in the control group only received the same dose of Ferrost sulfatis Et vitamini-medtech. The loss of blood of the patients during operation were estimated and recorded. Their Hb and Hct were mensured before operation, and in the first, third, seventh-twelfth day after operation.. In the twelfth day after operation, the Hb and Hct of the patients in the experiment group had a significantly higher increase than that in the control group (P<0.05).. rhEPO combined Ferrost sulfatis Et vitamini-medtech are suitable to apply in orthognathic patients with anemia after operation, which may effectively accelerate the recovery of their anemia, and avoid transfusion of blood.

Topics: Adolescent; Adult; Anemia; Erythropoietin; Female; Humans; Male; Mandible; Postoperative Complications; Recombinant Proteins

To investigate the effect of recombinant human erythropoietin (r-HuEPO) administration on perioperative hemoglobin concentrations and on the number of blood transfusions in patients undergoing surgery for gastrointestinal tract malignancies.. Erythropoietin has been shown to improve the yield of autologously predonated blood and to reduce the subsequent requirements for homologous blood transfusions in cancer patients.. In this double-blind placebo-controlled study, 31 cancer patients received subcutaneous r-HuEPO in a dose of 300 IU/kg body weight plus 100 mg iron intravenously (study group) and 32 patients received placebo medication and iron (control group). All patients received the medications daily for at least 7 days before and 7 days after the operation.. Patients who received erythropoietin received significantly fewer transfusions intraoperatively and postoperatively. Postoperatively, the study group had significantly higher hematocrit, hemoglobin, and reticulocyte count values compared to the control group. The use of erythropoietin was also associated with a reduced number of postoperative complications and improved 1-year survival.. Patients with gastrointestinal tract cancer and mild anemia benefit from perioperative erythropoietin administration in terms of stimulated erythropoiesis, reduction in the number of blood transfusions, and a favorable outcome.

Topics: Aged; Blood Loss, Surgical; Blood Transfusion; Double-Blind Method; Erythropoietin; Female; Gastrointestinal Neoplasms; Hematocrit; Hemoglobins; Humans; Male; Multivariate Analysis; Postoperative Complications; Preoperative Care; Prospective Studies; Recombinant Proteins; Reticulocyte Count; Survival Rate

Previous reports have suggested that the use of recombinant human erythropoietin is effective for decreasing the need for perioperative allogeneic blood transfusion. The purpose of this study was to evaluate the efficacy of erythropoietin in combination with, and compared with, preoperative autologous donation for reducing allogeneic blood requirements for total joint arthroplasty.. Two hundred and forty patients undergoing primary and revision total hip or knee arthroplasty were enrolled into three groups with different treatment regimens: (1) erythropoietin and preoperative autologous donation (Group 1), (2) erythropoietin alone (Group 2), and (3) preoperative autologous donation alone (Group 3). Patients were evaluated with regard to requirements for allogeneic transfusion, change from the baseline to the lowest postoperative hemoglobin value, postoperative complications, and adverse reactions.. The rate of allogeneic transfusion was 11% in Group 1 (erythropoietin and preoperative autologous donation) compared with 28% in Group 2 (erythropoietin alone) and 33% in Group 3 (preoperative autologous donation alone). Within Group 1, patients who had a unilateral primary arthroplasty had an allogeneic transfusion rate of 4% and those who had a bilateral or revision arthroplasty had an allogeneic transfusion rate of 17%. In Groups 2 and 3, the allogeneic transfusion rates were 14% and 15%, respectively, for the patients who had a unilateral primary arthroplasty and 35% and 47%, respectively, for those who had a bilateral or revision arthroplasty.. Preoperative use of erythropoietin in conjunction with preoperative autologous donation reduces the need for allogeneic blood transfusion associated with total joint arthroplasty more effectively than does either erythropoietin or preoperative autologous donation alone.

Topics: Aged; Aged, 80 and over; Analysis of Variance; Arthroplasty, Replacement; Blood Transfusion, Autologous; Erythropoietin; Female; Humans; Male; Middle Aged; Postoperative Complications; Preoperative Care; Prospective Studies; Recombinant Proteins

To evaluate the efficacy of perioperative recombinant human erythropoietin (r-HuEPO, epoetin alfa) in stimulating hematopoiesis and reducing allogeneic blood transfusion requirements in major head and neck cancer surgery.. Double-blinded, placebo-controlled, randomized, prospective clinical trial.. Fifty-eight patients undergoing surgical resection of head and neck tumors at the University of Iowa hospitals completed this study. Patients were required to have a pre-study hemoglobin >/=10.0 g/dL and

Topics: Adult; Aged; Aged, 80 and over; Anemia; Blood Loss, Surgical; Blood Transfusion; Double-Blind Method; Epoetin Alfa; Erythropoietin; Female; Head and Neck Neoplasms; Hematinics; Humans; Male; Middle Aged; Postoperative Complications; Prospective Studies; Recombinant Proteins

A prospective, randomized trial comparing Epoetin alfa (Procrit) with placebo saline injection to determine effectiveness in increasing erythropoietic recovery in complex spine deformity surgery.. To determine if Epoetin alfa can allow preoperative autologous donation completion more effectively and reduce perioperative homologous blood transfusion.. The use of Epoetin alfa has been studied, primarily in the arthroplasty literature, for its effectiveness in decreasing transfusion requirements and increasing hemoglobin levels. It has not been studied in patients undergoing complex spine deformity surgery.. A total of 48 patients were prospectively randomized into an Epoetin alfa group and a control group. All patients attempted to donate 4 units of preoperative autologous donation at weekly intervals; 40,000 units of Epoetin alfa were injected subcutaneously at the time of preoperative autologous donation in the Epoetin alfa group. Hematocrit levels were recorded weekly during the donation process and daily in the preoperative period.. Preoperative autologous donation was completed more effectively in the patients receiving Epoetin alfa. Epoetin alfa resulted in statistically higher hematocrit levels during preoperative autologous donation and perioperatively (P < 0.005). Homologous transfusion was decreased by 2.4 units and hospital stay was 1.8 days shorter in patients receiving Epoetin alfa.. Patients who received Epoetin alfa were able to complete preoperative autologous donation more effectively, increase erythropoietic recovery, decrease homologous transfusion requirements, and had shorter hospital stays.

Topics: Adult; Aged; Blood Donors; Blood Loss, Surgical; Blood Transfusion, Autologous; Constipation; Contraindications; Epoetin Alfa; Erythropoietin; Female; Fever; Hematocrit; Humans; Injections, Subcutaneous; Length of Stay; Male; Middle Aged; Postoperative Complications; Postoperative Nausea and Vomiting; Preoperative Care; Prospective Studies; Recombinant Proteins; Sepsis; Spinal Curvatures; Spinal Fusion; Treatment Outcome

A multicenter, randomized, open-label, parallel-group study was conducted to compare the safety and efficacy of perioperative recombinant human erythropoietin (Epoetin alfa) with the safety and efficacy of preoperative autologous donation (PAD) in total joint arthroplasty. A total of 490 patients scheduled for total joint (i.e., hip or knee) surgery and having hemoglobin (Hb) levels > or = 11 to < or = 13 g/dL were randomized to receive weekly doses of subcutaneous Epoetin alfa on preoperative Days -21, -14, and -7, and on the day of surgery, or to participate in a PAD program. The mean baseline Hb level in both groups was 12.3+/-0.6 g/dL, increasing to 13.8 g/dL in the Epoetin alfa-treated group and decreasing to 11.1 g/dL in the PAD group before or on the day of surgery. In the PAD group, 156/219 (71.2%) patients were transfused with autologous blood, and 42/219 (19.2%) patients were transfused with allogeneic blood. A smaller proportion, 27/209 (12.9%) patients, in the Epoetin alfa-treated group were transfused with allogeneic blood (P = .078 compared with the PAD group). Moreover, patients in the PAD group received a total of 325 units of blood (79 allogeneic units and 246 autologous units) compared with patients in the Epoetin alfa group who received a total of 54 units of blood. The mean postoperative Hb level was 11.0 g/dL in the Epoetin alfa-treated group and 9.2 g/dL in the PAD group. Compared with the PAD arm, mean Hb levels measured preoperatively, postoperatively on Day 1, and at discharge visits were significantly greater in the Epoetin alfa-treated arm (P < .0001 ).

Topics: Age Factors; Anemia; Arthroplasty, Replacement; Blood Loss, Surgical; Blood Transfusion; Blood Transfusion, Autologous; Epoetin Alfa; Erythropoietin; Hematinics; Hemoglobins; Humans; Postoperative Complications; Prospective Studies; Recombinant Proteins; Sex Factors

The authors present results of using recombinant human erythropoietin in patients operated on the heart under conditions of extracorporeal blood circulation. It was found that the intravenous infusions of erythropoietin at the postoperative period accelerated the restitution of circulating erythron indices. The volume of transfusion of the donor erythrocyte-containing media to the patient is given erythropoietin was reliably less than that in the control group. The results obtained allow using erythropoietin to be recommended as an effective method of prophylactics and treatment of anemia in cardiosurgical patients.

Topics: Adult; Anemia; Cardiac Surgical Procedures; Endocarditis, Bacterial; Erythropoietin; Extracorporeal Circulation; Female; Heart Defects, Congenital; Humans; Hypothermia, Induced; Male; Postoperative Care; Postoperative Complications; Recombinant Proteins; Rheumatic Heart Disease

The mechanism by which angiotensin-converting enzyme inhibitors reduce red cell mass in renal transplant recipients with erythrocytosis is unclear. To examine the role of angiotensin II in this disorder, losartan (a competitive antagonist of the angiotensin II type 1 [AT1] receptor) was administered to 23 patients with erythrocytosis. Fourteen patients took 25 mg/d for 8 wk; nine others were treated with 50 mg/d for 8 wk. Hematocrit decreased from 0.527 +/- 0.027 to 0.487 +/- 0.045 after 8 wk (P < 0.01)--by at least 0.04 in 19 patients. Decrement in hematocrit in the initial 8 wk of therapy was significantly greater in patients administered 50 mg/d than in patients on 25 mg/d. Twelve of 14 patients initially treated with 25 mg/d showed a small change in hematocrit; the dose was increased to 50 mg/d for 8 more wk. Hematocrit decreased from 0.528 +/- 0.030 before losartan treatment to 0.483 +/- 0.055 after 16 wk (P < 0.01). After therapy, serum erythropoietin significantly decreased in eight patients with elevated baseline levels, but not in 15 patients with normal baseline levels; however, hematocrit significantly decreased in both groups. Losartan was withdrawn in 16 patients; hematocrit increased from 0.440 +/- 0.057 to 0.495 +/- 0.049 after 8.9 +/- 7.5 wk (P < 0.001), without change in serum erythropoietin. Thus, specific blockade of AT1 receptors inhibited erythropoiesis, suggesting a pathogenic role for angiotensin II in posttransplant erythrocytosis.

Topics: Angiotensin Receptor Antagonists; Erythropoietin; Female; Hematocrit; Humans; Kidney Transplantation; Losartan; Male; Polycythemia; Postoperative Complications

Topics: Angiotensin-Converting Enzyme Inhibitors; Erythrocyte Count; Erythropoietin; Hematocrit; Humans; Kidney Transplantation; Losartan; Polycythemia; Postoperative Complications; Ramipril; Reticulocyte Count; Transferrin

Acute normovolaemic haemodilution (ANH) is used to avoid perioperative blood loss and consists of the withdrawal of whole blood just before or just after anaesthesia induction and its simultaneous replacement by synthetic colloids and crystalloid solutions. In an attempt to improve the efficiency of this technique while at the same time avoiding cardiovascular complications, we set up a pilot study to test the association of rHuEpo/ANH during elective surgery for total hip replacement. Five patients (3 males, 2 females) were included in this study. The amount of whole blood drawn was 3 x 450 ml from the men and 2 x 450 ml from the women. Before blood was taken, the mean increase in haemoglobin was 1.2 +/- 0.9 g/dl and mean increase in reticulocytes 106 +/- 34 G/l. No patient received homologous transfusion during the perioperative period; 3 patients received the totality of predonated blood and one patient 2 of the 3 units taken. The mean fall in haemoglobin at day 1 post-surgery was 3.6 g/dl. In conclusion, the stimulation of erythropoiesis by rHuEpo in the pre-surgery phase led on average to a 1 g/dl gain in haemoglobin, permitting an isovolaemic withdrawal of 900 to 1350 ml of blood depending on body weight without the development of severe anaemia. It was thus possible to perform total hip replacement in all the patients without homologous blood support and with a post-surgery haemoglobin value of > 10 g/dl. This protocol should be further tested in a prospective randomised study (rHuEpo versus placebo) in order to assess the real benefit of rHuEpo.

Topics: Adult; Aged; Arthroplasty, Replacement, Hip; Blood Loss, Surgical; Blood Transfusion; Erythropoietin; Female; Hemodilution; Hemoglobinometry; Humans; Male; Middle Aged; Pilot Projects; Postoperative Complications; Recombinant Proteins; Treatment Outcome

Two hundred patients who were scheduled for a major elective orthopaedic operation were enrolled in a prospective study and were randomly assigned to one of three treatment groups. Group 1 consisted of sixty patients who received recombinant human erythropoietin, 300 international units per kilogram of body weight per day; Group 2, seventy-one patients who received recombinant human erythropoietin, 100 international units per kilogram of body weight per day; and Group 3, sixty-nine patients who received a placebo. A total of fifteen doses was given subcutaneously, beginning ten days before the operation and extending through the fourth postoperative day. Patients who declined or were unable to donate autologous blood preoperatively were included in the study and were maintained on iron supplementation orally. The decision to transfuse red blood cells depended on the physician, however, physicians were encouraged not to do so if the hematocrit was more than 0.27 (27 per cent), unless the clinical symptoms warranted it. Of the 185 patients who were evaluable with regard to efficacy, significantly fewer patients received homologous red-blood-cell transfusions in Groups 1 and 2 (17 per cent [nine] and 25 per cent [sixteen], respectively) than in Group 3 (54 per cent [thirty-six]) (p < 0.001). When the patients were stratified into two groups on the basis of the pre-treatment hemoglobin level (more than 100 to 130 grams per liter or more than 130 grams per liter), we found that patients who had received a placebo and had a baseline hemoglobin level of more than 100 to 130 grams per liter were at significantly higher risk for transfusion (78 per cent [twenty-one]) than those who had received a placebo and had a baseline level of more than 130 grams per liter (36 per cent [fourteen]). For patients who had a baseline hemoglobin level of more than 100 to 130 grams per liter, the higher dose of recombinant human erythropoietin appeared somewhat more effective than the lower dose, with 14 per cent (three) of the patients in Group 1 and 39 per cent (nine) in Group 2 needing a transfusion; however, the difference was not significant (p = 0.09). For patients who had a baseline hemoglobin level of more than 130 grams per liter, the two doses of recombinant human erythropoietin produced similar results, with 14 per cent (four) of the patients in Group 1 and 11 per cent (four) in Group 2 needing a transfusion; this was in contrast to a rate of transfusion of 36 per cent (

Topics: Aged; Aged, 80 and over; Analysis of Variance; Dose-Response Relationship, Drug; Double-Blind Method; Erythrocyte Transfusion; Erythropoietin; Female; Hematocrit; Hemoglobins; Hip Prosthesis; Humans; Hypertension; Knee Prosthesis; Male; Middle Aged; Orthopedics; Postoperative Complications; Prospective Studies; Recombinant Proteins; Reticulocyte Count

We have recently shown that ketanserin, an antagonist of peripheral serotonin 5-HT2 receptors lowers blood erythropoietin (Epo) levels in some chronic hemodialysis patients. Based on this finding, a preliminary study was undertaken to investigate the effect of a 3-week oral ketanserin administration on serum Epo concentration and relevant hematological parameters in 4 renal allograft recipients with posttransplant erythrocytosis (PTE). We found a marked decrease in Epo concentrations following ketanserin administration, from 48% to 76% of the abnormally elevated pretreatment values with subsequent increases at 3 weeks after discontinuation of the drug in all patients studied. In 3 of them a corresponding decrease or no rise in the erythrocyte count were noted. During the 6-week study period, the need for monthly phlebotomies was eliminated in these patients. It is hypothesized that ketanserin diminishes erythropoietin synthesis and may become a new drug in the treatment of posttransplant erythrocytosis.

Topics: Adult; Erythropoietin; Humans; Ketanserin; Kidney Transplantation; Male; Middle Aged; Polycythemia; Postoperative Complications; Serotonin Antagonists; Transplantation, Homologous

Topics: Adult; Angiotensin-Converting Enzyme Inhibitors; Calcium Channel Blockers; Enalapril; Erythropoietin; Female; Hematocrit; Humans; Kidney Transplantation; Male; Nifedipine; Polycythemia; Postoperative Complications; Retrospective Studies; Time Factors

The optimum dosage of subcutaneous (s.c.) epoetin alfa was assessed in a double-blind study in 31 patients scheduled for cardiac surgery. Patients received a total of four doses of either epoetin alfa 150 IU/kg (n = 11), epoetin alfa 300 IU/kg (n = 10), or placebo (n = 10) administered as single s.c. injections at weekly intervals starting 23 days prior to surgery. AB was collected with isovolemic replacement prior to each of the first three doses of medication. During the AB donation period, Hb levels decreased significantly (P < .05) from baseline to surgery in the placebo group (16.5%), compared with no significant decrease in either of the epoetin alfa groups (8.1% and 9.7% in the 150 IU/kg and 300 IU/kg groups, respectively). In addition, the difference between groups with regard to the decrease in Hb level reached statistical significance (P < .05) for the 150 IU/kg group versus placebo. Epoetin alfa treatment was also associated with significantly higher reticulocyte counts and serum erythropoietin levels in the preoperative period compared with placebo.

Topics: Blood Transfusion; Blood Transfusion, Autologous; Cardiac Surgical Procedures; Dose-Response Relationship, Drug; Epoetin Alfa; Erythropoiesis; Erythropoietin; Humans; Injections, Subcutaneous; Iron; Postoperative Complications; Premedication; Recombinant Proteins; Treatment Outcome

A multicenter, double-blind, placebo-controlled, parallel-group study was undertaken to determine whether Epoetin alfa can reduce perioperative transfusion requirements. Twenty-six medical centers enrolled 316 patients who were scheduled for major orthopedic surgery and were expected to require > or = 2 units of blood. Patients were stratified according to baseline hemoglobin levels and randomly assigned to receive either Epoetin alfa (300 IU/kg or 100 IU/kg) or placebo for 15 consecutive days starting 10 days prior to, on the day of, and for 4 days after surgery. Epoetin alfa (300 IU/kg) resulted in significantly less exposure to allogeneic blood transfusion compared with placebo (16%) versus 45%) in patients whose baseline hemoglobin level was > 10 to < or = 13 g/dL (P = 0.024). Mean number of units transfused per patient was also lower among those treated with Epoetin alfa (overall, P = 0.027). Epoetin alfa was safe and well tolerated in this population.

Topics: Aged; Blood Loss, Surgical; Blood Transfusion; Double-Blind Method; Epoetin Alfa; Erythropoietin; Female; Hematinics; Hematocrit; Hemoglobinometry; Hip; Humans; Intraoperative Period; Knee; Male; Middle Aged; Orthopedics; Postoperative Complications; Preoperative Care; Recombinant Proteins; Risk Factors; Thrombosis

Topics: Captopril; Creatinine; Erythropoietin; Female; Follow-Up Studies; Hematocrit; Hemoglobins; Humans; Kidney Transplantation; Male; Nifedipine; Polycythemia; Postoperative Complications; Potassium; Time Factors

To evaluate the role of recombinant human erythropoietin in reducing the need for homologous blood transfusion during operations by studying its effect on the recovery of postoperative anaemia.. Randomised controlled trial.. University hospital, Japan.. 10 patients with gastric cancer undergoing distal gastrectomy.. 5 Patients were given erythropoietin 200 IU/kg/day together with ferric pyrophosphate 40 mg/day intravenously for seven days before operation and 14 days afterwards, and 5 were given ferric pyrophosphate 40 mg/day alone (control group).. Packed cell volume, haemoglobin concentration, and white and red cell counts.. There was no significant change in packed cell volume after the operation in the erythropoietin group, but in the control group it dropped from a mean (SD) of 0.378 (0.074) before operation to 0.329 (0.068) on day 1 (p < 0.05). Haemoglobin concentrations were significantly higher in the erythropoietin group than the control group on day 7 (mean (SD) 137 (14) compared with 110 (19) p < 0.05), and on day 10 (140 (9) compared with 108 (15) p < 0.01) after operation.. Erythropoietin prevented postoperative anaemia after gastrectomy as judged by packed cell volume, haemoglobin concentration, and red cell count. Erythropoietin given before and after operation therefore has the potential to reduce the need for homologous blood transfusion during and after major operations.

Topics: Adult; Aged; Anemia; Blood Cell Count; Diphosphates; Erythropoietin; Female; Gastrectomy; Hematocrit; Hemoglobins; Humans; Iron; Male; Middle Aged; Pilot Projects; Postoperative Care; Postoperative Complications; Preoperative Care; Recombinant Proteins; Stomach Neoplasms; Time Factors

We evaluated the role of recombinant human erythropoietin (RHE) for treatment of severe postsurgical anemia (Hct < 25%) in 40 Jehovah's Witness (JW) patients refusing transfusion. Twenty patients (group E) received RHE either at a loading dose of 300 U/kg iv 3 times/week for 1 week followed by 150 U/kg 3 times/week in accordance with an IRB approved protocol (N = 13), or at a dose of 100 U/kg 3 times/week for humanitarian reasons (N = 7). This group was compared to 20 similar JW patients who did not receive RHE (group C). All patients received iron restoration and nutritional support. Non-parametric analysis (Mann-Whitney) was used because of sample size. Entry hematocrit was similar for both groups: H(E)(0) = 15.8% +/- 1.1 SEM (8.5-23.4) vs HC (0) = 12.8% +/- 0.9 SEM (7.3-20.6), P = 0.09. After one week, hematocrit was significantly higher in group E (H(E)(1)) = 19.3 +/- 1.1 vs HC(1) = 12.5% +/- 0.9, P < 0.0005) as was the increase in hematocrit for group E (3.6% +/- 0.9 for E vs -0.4% +/- 0.8 for C, P < 0.005). Hematocrit change in Week 2 showed an increase for both groups (2.9 +/- 0.6 for E vs 4.9% +/- 1.2 for C, P = 0.12).. Hct recovery shows a 1-week lag in severely anemic postsurgical patients treated without RHE. Exogenous RHE appears to accelerate hematocrit recovery in the first week. Use of RHE in the immediate postoperative period may help avoid or reduce homologous blood transfusion.

Topics: Anemia; Blood Transfusion; Christianity; Combined Modality Therapy; Drug Administration Schedule; Erythropoietin; Female; Hematocrit; Humans; Infusions, Intravenous; Male; Middle Aged; Nutritional Support; Postoperative Complications; Recombinant Proteins; Severity of Illness Index; Time Factors; Treatment Refusal

Topics: Adult; Aged; Anemia; Blood Transfusion, Autologous; Elective Surgical Procedures; Erythropoietin; Female; Humans; Male; Middle Aged; Postoperative Complications; Preoperative Care; Recombinant Proteins; Time Factors

We evaluated the benefit of autologous blood transfusion and the effect of recombinant human erythropoietin (rh-EPO) on preoperative autologous blood donation for hepatectomy in patients with cirrhosis.. Forty-two patients with cirrhosis and hepatocellular carcinoma underwent hepatectomy, 21 of whom (group A) donated autologous blood before operation. Eleven of these patients (group A1) were administered rh-EPO before operation, and ten patients (group A2) were untreated. Twenty-one patients (group B) did not donate autologous blood.. The frequency of homologous blood transfusion was 24% in group A and 62% in group B (p < 0.05). Preoperative erythropoiesis increased markedly in group A1, and postoperative erythropoietin production was not suppressed in this group. Postoperative hematocrits recovered significantly more rapidly in patients transfused with only autologous blood. Postoperative serum total bilirubin concentrations were significantly higher in patients with transfused homologous blood.. Autologous blood transfusion yields clinically superior results for hepatectomy in patients with cirrhosis when compared with homologous transfusion. Preoperative rh-EPO administration minimizes presurgical decreases in hematocrit caused by autologous blood donation.

Topics: Adult; Aged; Bilirubin; Blood Transfusion, Autologous; Carcinoma, Hepatocellular; Erythropoietin; Female; Hematocrit; Hepatectomy; Humans; Liver Cirrhosis; Liver Function Tests; Liver Neoplasms; Male; Middle Aged; Postoperative Complications; Recombinant Proteins

Concern about the risk of transmission of viral infection has led to attempts to reduce transfusion requirements in patients undergoing surgery. To determine whether recombinant human erythropoietin decreases blood transfusion requirements in patients undergoing elective hip arthroplasty, a multicentre double-blind, randomised, placebo-controlled trial was conducted. 208 patients undergoing elective primary or revision hip arthroplasty were randomised to 3 groups. All received daily subcutaneous injections of either erythropoietin or placebo starting 10 days before surgery. Group 1 (78 patients) received 14 days of placebo, group 2 (77 patients) received 14 days of erythropoietin (300 units/kg to a maximum of 30,000 units), and group 3 (53 patients) received placebo for days 10 to 6 before surgery and erythropoietin for the next 9 days. A primary outcome event (any transfusion or a haemoglobin concentration < 80 g/L) occurred in 46% of patients in group 1, 23% in group 2, and 32% in group 3 (p = 0.003). The mean number of transfusions was 1.14 in group 1, 0.52 in group 2, 0.70 in group 3. The mean reticulocyte count the day before surgery was 72 x 10(9)/L in group 1, 327 in group 2, and 170 in group 3. Deep venous thrombi were detected in 5 patients in group 1, 8 patients in group 2, and 8 patients in group 3. Patients who had a haemoglobin concentration before randomisation of < 135 g/L benefited most from erythropoietin. Thus erythropoietin given for 14 days perioperatively decreases the need for transfusion in patients undergoing elective hip arthroplasty.

Topics: Aged; Blood Cell Count; Blood Loss, Surgical; Blood Pressure; Blood Transfusion; Double-Blind Method; Drug Administration Schedule; Erythropoietin; Female; Ferritins; Follow-Up Studies; Hemoglobins; Hip Prosthesis; Humans; Injections, Subcutaneous; Iron; Male; Middle Aged; Postoperative Complications; Recombinant Proteins; Thrombophlebitis; Treatment Outcome

Topics: Blood Transfusion; Erythropoietin; Hip Prosthesis; Humans; Postoperative Complications; Recombinant Proteins; Thrombophlebitis

Anaemia is common in children following cardiac transplantation. In a series of 5 children with anaemia beyond the immediate post-operative period one had a hypochromic, microcytic anaemia which corrected with oral iron. The other four had normochromic, normocytic anaemias unresponsive to iron or folate supplementation and associated with inappropriately low levels of erythropoietin. Subcutaneous administration of low dose human recombinant erythropoietin to these four patients resulted in correction of their anaemia. Our findings suggest that erythropoietin deficiency is an important cause of anaemia in transplant recipients and should be sought in cases of anaemia refractory to conventional haematinic therapy. In cases of proven erythropoietin deficiency, treatment with erythropoietin is effective, acceptable to patients and preferable to repeated blood transfusion.

Topics: Adolescent; Anemia; Blood Urea Nitrogen; Child; Child, Preschool; Creatinine; Cyclosporins; Erythropoietin; Heart Transplantation; Hemoglobins; Humans; Infant; Postoperative Complications

Plasma erythropoietin levels were determined by Keighley's method to study the changes in erythropoiesis before and after human renal homotransplantation. Results. Erythropoietin titres in pre-transplant patients were low, while they returned to normal after successful renal transplantation. In acute rejection they were significantly high. After its reversal normal levels of erythropoietin were obtained in accordance with a normalization of the graft functions. Reticulocyte counts paralleled with erythropoietin values. Conclusion. High levels of plasma erythropoietin contribute to the diagnosis of acute rejection. Normalization of the plasma erythropoietin levels after the acute rejection could be regarded as an indication for good function of the graft. The grafted kidneys seem to function in producing erythropoietin.

Topics: Adult; Aminohippuric Acids; Blood Urea Nitrogen; Clinical Trials as Topic; Creatinine; Erythropoietin; Female; Graft Rejection; Hemoglobins; Humans; Kidney Transplantation; Male; Nephritis; Postoperative Complications; Reticulocytes; Transplantation, Autologous; Tuberculosis, Renal; Ureteral Obstruction

The purpose of our study is to identify the effect of short-term and high-dose use of erythropoietin (EPO) in spinal isolated metastatic patients with Total en bloc spondylectomy (TES) surgery by assessing hematological parameters, transfusion volume, postoperative complications, recurrence-free survival (RFS), and overall survival (OS).. From January 2015 and January 2022, 93 isolated spinal metastasis patients were selected and separated into 2 groups based on the treatment method used (EPO + TXA (Tranexamic acid) group, n = 47; and TXA group, n = 46). Indexes for evaluation included hemoglobin (Hb), hematocrit (Hct), red blood cells (RBC), RFS, OS, postoperative complications, postoperative Frankel Grade, drainage volume, transfusion rate, and mean units transfused.. The average follow-up duration was 38.13 months. There was no significant difference (P > 0.05) in RFS, OS, postoperative complications, postoperative Frankel Grade, drainage volume, and transfusion rate between the two groups. However, patients in EPO + TXA group have significantly higher Hb, Hct, and RBC values than those in the TXA group on postoperative days 1, 2, 3, and 5. Moreover, the mean transfusion volume in EPO + TXA group was significantly lower than those in the TXA group (P = 0.011).. Perioperative short-term and high-dose administration of EPO could improve the anemia-related hematological parameters and reduce the requirement for blood transfusion without increasing the risk of deep vein thrombosis and tumor progression in solitary spinal metastatic patients with TES surgery.

Topics: Antifibrinolytic Agents; Blood Loss, Surgical; Case-Control Studies; Erythropoietin; Humans; Postoperative Complications; Spinal Neoplasms

To share our initial experience with the innovative use of topical erythropoietin for the treatment of necrotizing scleritis manifesting immediately after pterygium excision surgery.. This study enrolled 3 patients who developed necrotizing scleritis immediately after undergoing pterygium excision. All cases with pterygium were primary, and topical mitomycin C and conjunctival autografts were used at the time of surgery. Noninvasive therapy that included ophthalmic lubricants and topical and systemic corticosteroids failed to improve the avascular scleral lesions. The patients were prescribed erythropoietin-containing drops (3000 U/mL) every 6 hours in addition to topical antibiotics and lubricant. The effect of topical erythropoietin on the healing process of avascular scleral lesions was investigated, and its ocular and systemic side effects were evaluated.. The mean age of the participants was 69.0 ± 14.8 years, and 2 of the 3 eyes belonged to male subjects. The time between pterygium surgery and presentation to our clinic was 33.0 ± 14.7 days. There were no infectious causes or underlying systemic diseases in any of the cases. After treatment with topical erythropoietin for an average of 34.3 ± 20.3 days, the lesions were completely vascularized in all 3 eyes without any ocular or systemic adverse effects. The patients were followed up for an average of 126 ± 94 days after discontinuation of erythropoietin. There was no evidence of recurrence during the last examination in any of the eyes.. Topical erythropoietin might be a safe and an effective method for treating cases of necrotizing scleritis that manifests immediately after pterygium surgery.

Topics: Administration, Topical; Aged, 80 and over; Conjunctiva; Erythropoietin; Female; Follow-Up Studies; Humans; Male; Middle Aged; Necrosis; Ophthalmologic Surgical Procedures; Pilot Projects; Postoperative Complications; Pterygium; Retrospective Studies; Sclera; Scleritis; Treatment Outcome

Dysmotility and postoperative ileus (POI) are major clinical problems after surgical trauma and it is associated with increased intestinal inflammation and oxidative stress. Despite the high occurrence of POI following intra-abdominal surgeries, no effective treatment is currently available. Erythropoietin (EPO) is a multifunctional tissue-protective cytokine with potent anti-inflammatory and anti-oxidative properties, and it is an FDA approved medicine for clinical use. While both EPO and EPO receptors (EPOR) are widely expressed in the gut, the role of EPO in POI is largely unknown. This study was designed to explore the possible beneficial effect of EPO in a mouse model of POI.. Mice were subjected to intestinal manipulation to induce standard POI and intestinal transit time was determined at 24-h post-injury with or without EPO treatment (5000 units/kg, once, IP, immediately after intestinal trauma). Intestinal samples were harvested for histological and immunohistochemical analysis.. Systemic EPO significantly improved intestinal transit time compared with control group and it was associated with significantly increased levels of tissue macrophages and reduced levels of oxidative stress.. This is the first pre-clinical study to document novel beneficial effects of EPO in gut dysmotility and our findings suggest that the beneficial effects of EPO in POI is predominantly mediated by its anti-oxidative and immunomodulatory properties.

Topics: Animals; Disease Models, Animal; Erythropoietin; Gastrointestinal Motility; Intestinal Pseudo-Obstruction; Male; Mice; Mice, Inbred C57BL; Postoperative Complications; Recovery of Function

Topics: Administration, Intravenous; Administration, Oral; Adult; Anemia; Blood Transfusion; Cardiac Surgical Procedures; Erythrocyte Count; Erythropoietin; Female; Ferric Oxide, Saccharated; Hemoglobins; Humans; Male; Middle Aged; Postoperative Complications; Retrospective Studies; Thoracotomy; Treatment Outcome

Acquired pure red cell aplasia (PRCA) is characterized by severe normocytic (rarely macrocytic) and normochromic anemia, a low reticulocytes count in peripheral blood, and near absence of erythroid precursors in the bone marrow, with a normal level of erythropoietin. We describe a case of the kidney transplant recipient, diagnosed with PRCA induced with parvovirus B19 infection. Our case demonstrates that although this complication is rare, it should be considered in a differential diagnosis of anemia diagnostics in immunocompromised patients. In our case reduced immune response resulted from post-transplant immunosuppressive therapy. In our patient, apart from infection by parvovirus B19, graft dysfunction due to polyomavirus BK virus infection was also detected together with histologic and serologic features of antibody-mediated renal graft rejection. Considering the entire clinical picture, intravenous immunoglobulin therapy (IVIg) was successfully introduced.

Topics: Antibodies, Viral; Erythema Infectiosum; Erythropoietin; Female; Graft Rejection; Humans; Immunocompromised Host; Immunoglobulins, Intravenous; Kidney Transplantation; Male; Middle Aged; Parvovirus B19, Human; Postoperative Complications; Red-Cell Aplasia, Pure

The refusal of blood transfusions compels surgeons to face ethical and clinical issues. A single-institution experience with a dedicated perioperative blood management protocol was reviewed to assess feasibility and short-term outcomes of true bloodless pancreatic surgery.. The institutional database was reviewed to identify patients who refused transfusion and were scheduled for elective pancreatic surgery from 2010 through 2018. A protocol to optimize the hemoglobin values by administration of drugs stimulating erythropoiesis was systematically used.. Perioperative outcomes of 32 Jehovah's Witnesses patients were included. Median age was 67 years (range, 31-77). Nineteen (59.4%) patients were treated with preoperative erythropoietin. Twenty-four (75%) patients underwent pylorus-preserving pancreaticoduodenectomy, 4 (12.5%) distal pancreatectomy (DP) with splenectomy, 3 (9.4%) spleen-preserving DP, and 1 (3.1%) total pancreatectomy. Median estimated blood loss and surgical duration were 400 mL (range, 100-1000) and 470 min (range, 290-595), respectively. Median preoperative hemoglobin was 13.9 g/dL (range, 11.7-15.8) while median postoperative nadir hemoglobin was 10.5 g/dL (range, 7.1-14.1). The most common histological diagnosis (n = 15, 46.9%) was pancreatic ductal adenocarcinoma. Clavien-Dindo grade I-II complications occurred in fourteen (43.8%) patients while one (3.1%) patient had a Clavien-Dindo grade IIIa complication wich was an abdominal collection that required percutaneous drainage. Six (18.8%) patients presented biochemical leak or postoperative pancreatic fistula grade B. Median hospital stay was 16 days (range, 8-54) with no patient requiring transfusion or re-operation and no 90-day mortality.. A multidisciplinary approach and specific perioperative management allowed performing pancreatic resections in patients who refused transfusion with good short-term outcomes.

Topics: Adult; Aged; Blood Loss, Surgical; Blood Transfusion; Bloodless Medical and Surgical Procedures; Carcinoma, Pancreatic Ductal; Erythropoietin; Feasibility Studies; Female; Hemoglobins; Humans; Jehovah's Witnesses; Length of Stay; Male; Middle Aged; Pancreatectomy; Pancreatic Neoplasms; Pancreaticoduodenectomy; Perioperative Care; Postoperative Complications; Splenectomy; Treatment Outcome; Treatment Refusal

Anemia is one of severe complications in the perioperative period of total hip arthroplasty (THA). Erythropoietin (EPO) has been considered to improve patients' anemia state, but its efficiency and safety remains controversial.. A total of 152 patients who underwent total hip arthroplasty from January 2017 to March 2019 were randomized to 2 groups. Recombinant human erythropoietin (rHu-EPO) group was treated with rHu-EPO subcutaneous injection 10000 IU after operation and once daily in the next week, while control group was treated with none extra treatment. Routine hematologic examination and thrombelastography (TEG) performed at different time point respectively. Doppler ultrasound for bilateral lower limbs was performed 1 day before surgery and 7 days after surgery. Auxiliary examination outcomes, blood transfusions outcomes, and postoperative complications were recorded as assessment indicators.. The difference in the relevant indexes of traditional coagulation and TEG values between two groups were not significantly. No significant difference was observed in the incidence of thromboembolism events and other complications between two groups during postoperative period. The amount of intraoperative blood loss was similar between the two groups. However, the postoperative use and dosage of allogeneic blood in the rHu-EPO group were lower than those in the control group. The hemoglobin and hematocrit level in the rHu-EPO group were higher than that in the control group after surgery.. Postoperative subcutaneous injection of rHu-EPO can improve hematological anemia-related parameters, reduce the use and dosage of allogeneic blood transfusions (ABTs), and has no significant influence on the formation of thrombosis and other complications in patients undergoing total hip arthroplasty in short term.

Topics: Aged; Anemia; Arthroplasty, Replacement, Hip; Erythropoietin; Female; Humans; Injections, Subcutaneous; Male; Middle Aged; Perioperative Period; Postoperative Complications; Prospective Studies; Recombinant Proteins; Severity of Illness Index; Thrombelastography; Thrombosis

Anaemia after kidney transplantation may reduce quality of life, graft or patient survival. We aimed to determine the prevalence and risk factors for anaemia in the initial 12 months after transplantation.. We conducted a cross-sectional study at 6 and 12 months after transplantation. Anaemia was defined by World Health Organization criteria taking into consideration erythropoietin use. Logistic regression was used to determine the association between demographic, clinical and pharmacological risk factors for the main outcome of moderate-severe anaemia.. A total of 336 transplant recipients were included and the prevalence of moderate-severe anaemia was 27.4% at 6 months and 15.2% at 12 months. Lower kidney function, female gender, transferrin saturation below 10% and proteinuria were associated with moderate-severe anaemia at both time points. Recent intravenous immunoglobulin treatment was associated with anaemia at 6 months. Recent infection and acute rejection were also associated with anaemia 12 months. Around 20% of patients had at least one blood transfusion but they were uncommon beyond 3 months.. Anaemia remains highly prevalent requiring treatment with erythropoietin and transfusions. Most identifiable risk factors relate to clinical problems rather than pharmacological management, while markers of iron-deficiency remain difficult to interpret in this setting.

Topics: Adult; Anemia; Blood Transfusion; Cross-Sectional Studies; Erythropoietin; Female; Graft Survival; Hematinics; Humans; Immunoglobulins, Intravenous; Immunosuppressive Agents; Kidney Transplantation; Male; Middle Aged; Postoperative Complications; Quality of Life; Risk Factors; Survival Rate

To describe the perioperative blood conservation strategies and postoperative outcomes in patients who undergo complex spinal surgery for tumor resection and who also refuse blood product transfusion.. A retrospective case series.. A single-center, tertiary care and academic teaching hospital in Canada.. All adult patients undergoing elective major spine tumor resection and refusing blood product transfusion who were referred to our institutional Blood Utilization Program between June 1, 2004, and May 9, 2014.. Data on the use of iron, erythropoietin, preoperative autologous blood donation, acute normovolemic hemodilution, antifibrinolytic therapy, cell salvage, intraoperative hypotension, and active warming techniques were collected. Data on perioperative hemoglobin nadir, adverse outcomes, and hospital length of stay were also collected.. Four patients who refused blood transfusion (self-identified as Jehovah's Witnesses) underwent non-emergent complex spine surgery for recurrent chondrosarcoma, meningioma, metastatic adenocarcinoma, and metastatic malignant melanoma. All patients received 1 or more perioperative blood conservation strategy including preoperative iron and/or erythropoietin, intraoperative antifibrinolytic therapy, and cell salvage. No patients experienced severe perioperative anemia (average hemoglobin nadir, 124 g/L) or anemia-related postoperative complications.. Patients who decline blood product transfusion can successfully undergo major spine tumor resection. Careful patient selection and timely referral for perioperative optimization such that the risk of severe anemia is minimized are important for success.

Topics: Adult; Antifibrinolytic Agents; Blood Transfusion, Autologous; Erythropoietin; Female; Hemodilution; Humans; Intraoperative Care; Iron; Jehovah's Witnesses; Male; Middle Aged; Postoperative Complications; Preoperative Care; Retrospective Studies; Spinal Neoplasms

N-acetyl-seryl-aspartyl-lysyl-proline (AcSDKP) is a natural inhibitor of pluripotent hematopoietic stem cell proliferation and is normally found in human plasma. Because AcSDKP is partially eliminated in urine, accumulation of AcSDKP due to chronic renal failure may cause anemia. However, the status of plasma AcSDKP level in stable kidney transplant recipients is unknown although some recipients develop anemia after kidney transplantation. In this study, we investigated the relationship between plasma AcSDKP-like immunoreactive substance (IS) level and clinical characteristics associated with renal anemia in stable kidney transplant recipients.. Forty Japanese kidney transplant recipients who underwent transplantation more than 90 days prior to the study were included. Morning blood samples were collected and plasma AcSDKP-IS levels were measured using an enzyme immunoassay.. A significant correlation was observed between plasma AcSDKP-IS level and creatinine clearance. On the other hand, no significant correlation was observed between plasma AcSDKP-IS level and prolyl oligopeptidase activity, angiotensin II, or erythropoietin level. A significant difference in plasma AcSDKP-IS level was observed between recipients with no renal anemia and those with renal anemia.. These results suggest that plasma AcSDKP level may depend largely on renal function and suggest a possibility that accumulation of AcSDKP may be partially involved in the pathogenesis of renal anemia in stable kidney transplant recipients.

Topics: Adolescent; Adult; Aged; Anemia; Angiotensin II; Biomarkers; Creatinine; Erythropoietin; Humans; Kidney Failure, Chronic; Kidney Transplantation; Middle Aged; Oligopeptides; Postoperative Complications; Prolyl Oligopeptidases; Serine Endopeptidases; Young Adult

The liberal use of transfusions is not only a risk for patients but also represents a significant healthcare expenditure. The rational use of allogeneic blood transfusions and the use of transfusion alternatives, such as the optimization of preoperative hemoglobin levels, can offer substantial savings to health departments by reducing the cost of transfusions and the morbidity related to the transfusions.

Topics: Anemia; Blood Banks; Blood Loss, Surgical; Blood Transfusion; Cost Savings; Cost-Benefit Analysis; Erythropoietin; Hematinics; Hematologic Tests; Hospital Costs; Humans; Iron; Perioperative Care; Postoperative Complications; Recombinant Proteins; Risk; Transfusion Reaction

Based on its pleiotropic effects, erythropoietin can decrease inflammation, oxidative stress, and apoptosis. Erythropoietin provides organ protection for the heart, brain, and kidney in diverse preclinical animal studies, especially models that include ischemia-reperfusion injury and/or inflammation. However, large clinical studies in coronary reperfusion, heart failure, stroke, acute kidney injury, and chronic renal disease have failed to demonstrate improved outcomes. A study in a previous issue of Critical Care examining the ability of erythropoietin to prevent or ameliorate acute kidney injury in patients undergoing complex valvular heart surgery is similarly negative. The failure of erythropoietin in clinical studies may be due to an inadequate dose, since the receptors responsible for organ protection may require higher concentrations than those responsible for erythropoiesis. However, as has occurred in studies in sepsis and acute respiratory distress syndrome, the negative studies probably reflect an inadequate understanding of the complexity of the underlying processes with multiple redundant and interacting pathways that may differ among the large number of different cell types involved. As tools to understand this complexity and integrate it on an organismal basis continue to evolve, we will develop the ability to use erythropoietin and related nonhematopoietic agents for organ protection.

Topics: Acute Kidney Injury; Erythropoietin; Female; Heart Valve Diseases; Hematinics; Humans; Male; Postoperative Complications

The association of anemia with outcomes after renal transplantation (RT) is unclear.. We performed a retrospective study that included patients who received a RT in Spain in 2007. We collected data on anemia (hemoglobin [Hb] <11 g/dL and/or erythropoietic agents and/or transfusion in the previous month) as well as transplantation and clinical data during follow-up. We used multivariate Cox models to predict graft and patient survival.. We included 639 patients; 7.2% lost their graft and 6.3% died. The prevalence of anemia was 84% at 7 days, 77% at 1 month, 41% at 2 months, 16% at 12 months, 14% at 24 months, and 18% at 36 months. After adjusting by glomerular filtration rate (hazard ratio [95% confidence interval], 0.96 [0.93-0.98]), low Hb levels at 1 month remained as an independent predictor of graft loss (hazard ratio for each 1 g/dL increase, 0.72 [0.54-0.96]) along with a maximum panel-reactive antibody of more than 10% (3.80 [1.73-8.36]), a donor with stroke (3.30 [1.31-8.28]), and one or more acute rejection episode (13.89 [4.78-40.37]). Tacrolimus use was a protective factor (0.24 [0.11-0.50]).. Low Hb levels in the early posttransplantation period (1 month) seem to be an independent prognostic factor for graft loss, but not for mortality, in Spanish RT patients regardless of graft function, recipient and donor characteristics, unfavorable events within the first month, and immunosuppression.

Topics: Adult; Aged; Anemia; Erythropoietin; Female; Graft Survival; Hemoglobins; Humans; Kidney Transplantation; Male; Middle Aged; Morbidity; Multivariate Analysis; Postoperative Complications; Predictive Value of Tests; Prevalence; Proportional Hazards Models; Retrospective Studies; Risk Factors

Revision total knee arthroplasty (TKA) can be quite challenging in Jehovah's Witness patients because blood transfusion is often needed, however, these patients do not accept allogeneic or autologous blood due to religious convictions. We reported our clinical experiences with a special blood management protocol for Jehovah's Witnesses who underwent a revision TKA. There were 12 self-reported Jehovah's Witness patients (12 total knee arthroplasties) who had a mean age of 69 years (range: 55 to 79 years) and who underwent revision TKA between 1998 and 2009. All revision surgeries were due to aseptic component failure. Implant survivorship was 100% over a mean follow-up of 62 months (range: 24 to 120 months). The Knee Society objective and function scores improved to a mean of 83 and 82 points, respectively. The authors believe that the use of this blood management protocol was responsible for the excellent clinical outcomes.

Topics: Aged; Arthroplasty, Replacement, Knee; Erythropoietin; Female; Folic Acid; Follow-Up Studies; Hematinics; Hemostasis, Surgical; Humans; Iron; Jehovah's Witnesses; Male; Middle Aged; Operative Time; Phlebotomy; Postoperative Care; Postoperative Complications; Preoperative Care; Reoperation

Cardiovascular disease (CVD) is the main cause of mortality in renal transplant recipients (RTR). Classical factors only partly explain the excess risk. We hypothesized that high EPO--a marker for inflammation, angiogenesis and hypoxia--is associated with CVD in RTR. A total of 568 RTR (51±12 years; 45% female; creatinine clearance (CrCl) 57±20 mL/min/1.73 m(2)) were included at median 6 [IQR 3-11] years after transplantation. Subjects on exogenous EPO and ferritin-depleted subjects were excluded. Median EPO level was 17.3 [IQR 11.9-24.2] IU/L. Gender-stratified tertiles of age-corrected EPO were positively associated with waist circumference (but not BMI), CVD history, time since transplantation, diuretics, azathioprine, CRP, mean corpuscular volume and triglyceride levels, and inversely with CrCl, RAAS-inhibition, cyclosporine, hemoglobin, total- and HDL-cholesterol. During follow-up for 7 [6-7] years, 121 RTR (21%) died, 64 of cardiovascular (CV) causes. Higher EPO (per 10 IU/L) was associated with total (HR1.16 [1.04-1.29], p = 0.01) and CV mortality (HR1.22 [1.06-1.40], p = 0.005), independent of age, gender, hemoglobin, inflammation, renal function and Framingham risk factors. Thus, EPO and mortality are linked in RTR, independent of potential confounders. This suggests that yet other mechanisms are involved. Dissecting determinants of EPO in RTR may improve understanding of mechanisms behind excess CV risk in this population.

Topics: Age Factors; Biomarkers; Cardiovascular Diseases; Cause of Death; Erythropoietin; Female; Follow-Up Studies; Humans; Kidney Transplantation; Male; Middle Aged; Netherlands; Postoperative Complications; Prognosis; Prospective Studies; Risk Factors; Sex Factors; Survival Rate

To study the effect of a preparation by erythropoietin before Onlay's intervention on postoperative hematocrits and medium-term results of the surgery.. Twenty-one patients were operated on by Onlay's technique between 2001 January and 2008 September, after being treated by erythropoietin. Seven had a midshaft hypospadias, two a posterior hypospadias and 12 a penoscrotal hypospadias. All children were examinated four months after surgery to evaluate the surgical results.. After the surgery, 18 children had an apical meatus (85.7%). Three had a balanopreputial meatus, two a stenosis of the meatus. Two children were reoperated on, one with the Duplay's technique, the other for a meatostomy. No fistula, no necrosis of the preputial flap was observed. The preoperative hematocrit was measured at 41%, with an increase of 3.8% because of the preparation. Peroperative blood loss was evaluated at 6.6%. After surgery, 12 children had an hematocrit inferior than 35%, four an hematocrit inferior than 30%. No transfusion was needed.. Preparation by erythropoietin before severe hypospadias surgery seemed to have several advantages: a more elevated hematocrit after surgery than with an iron preparation alone, and a lower rate of postoperative complications, including fistulas and necrosis of the preputial flap.

Topics: Erythropoietin; Humans; Hypospadias; Infant; Male; Postoperative Complications; Preoperative Care; Retrospective Studies; Severity of Illness Index; Urologic Surgical Procedures, Male

The aim of this retrospective cohort study was to identify early risk factors of mortality and develop a mortality risk stratification instrument for severely anaemic Jehovah's Witness patients. It has been shown that Jehovah's Witness patients with the Auckland Anaemia Mortality Risk Score (Auckland AMRS) of 0 to 3 had 4% mortality, Auckland AMRS 4 to 5 32%, Auckland AMRS 6 to 7 50% and Auckland AMRS 8 and above 83%. It is concluded that the Auckland AMRS predicts mortality of severely anaemic Jehovah's Witness patients.

Topics: Adolescent; Adult; Aged; Anemia; Cardiovascular Diseases; Erythropoietin; Factor VIIa; Female; Filgrastim; Folic Acid; Granulocyte Colony-Stimulating Factor; Hemorrhage; Hospital Mortality; Hospitals, Public; Humans; Infections; Iron; Jehovah's Witnesses; Kidney Failure, Chronic; Male; Middle Aged; New Zealand; Plasma; Postoperative Complications; Recombinant Proteins; Retrospective Studies; Risk Assessment; Risk Factors; Vitamin B 12; Young Adult

Acute renal injury is one of the most frequent complications after cardiopulmonary bypass (CPB). This study was designed to evaluate the potential protective effect of erythropoietin (EPO) on CPB-induced renal injury in a rat model. Male Sprague-Dawley rats were randomly divided into three groups, sham-operated group (sham), control CPB group (control), erythropoietin CPB group (EPO). Blood samples were collected at the beginning, at the end of CPB, and at 0.5, 1, 2 and 24 h post-operation, and the kidneys were harvested 24 h postoperatively and observed by optical microscopy. Levels of serum creatinine (Cr) and blood urea nitrogen (BUN) were assayed. Tumor necrosis factor-α (TNF-α), interleukin-1β (IL-1β) and interleukin-6(IL-6) levels in the renal tissues were evaluated by the method of enzyme linked immunosorbent assay (ELISA). Protein and mRNA levels of nuclear factor kappa B p65 (NF-κB p65), intercellular adhesion molecule-1 (ICAM-1) were also determined using western blot and real-time PCR respectively. Serum Cr and BUN levels as well as TNF-α, IL-1β and IL-6 levels in renal tissues in control group were significantly higher than those in the sham group. However, the levels of above biomarkers were markedly decreased in EPO group when comparing with control group. Furthermore, NF-κB p65, ICAM-1 protein and mRNA expression were significantly down-regulated in EPO group comparing with control group. In addition, microscopic examinations revealed that histological injury was alleviated when treated with EPO. The results indicated that EPO potently protected against CPB-induced acute renal injury and inhibited expression of NF-κB p65 and inflammatory response.

Topics: Acute Kidney Injury; Animals; Cardiopulmonary Bypass; Erythropoietin; Gene Expression Regulation; Inflammation Mediators; Male; Postoperative Complications; Random Allocation; Rats; Rats, Sprague-Dawley; Transcription Factor RelA

Jehovah's Witness patients (Witnesses) who undergo cardiac surgery provide a unique natural experiment in severe blood conservation because anemia, transfusion, erythropoietin, and antifibrinolytics have attendant risks. Our objective was to compare morbidity and long-term survival of Witnesses undergoing cardiac surgery with a similarly matched group of patients who received transfusions.. A total of 322 Witnesses and 87 453 non-Witnesses underwent cardiac surgery at our center from January 1, 1983, to January 1, 2011. All Witnesses prospectively refused blood transfusions. Among non-Witnesses, 38 467 did not receive blood transfusions and 48 986 did. We used propensity methods to match patient groups and parametric multiphase hazard methods to assess long-term survival. Our main outcome measures were postoperative morbidity complications, in-hospital mortality, and long-term survival.. Witnesses had fewer acute complications and shorter length of stay than matched patients who received transfusions: myocardial infarction, 0.31% vs 2.8% (P = . 01); additional operation for bleeding, 3.7% vs 7.1% (P = . 03); prolonged ventilation, 6% vs 16% (P < . 001); intensive care unit length of stay (15th, 50th, and 85th percentiles), 24, 25, and 72 vs 24, 48, and 162 hours (P < . 001); and hospital length of stay (15th, 50th, and 85th percentiles), 5, 7, and 11 vs 6, 8, and 16 days (P < . 001). Witnesses had better 1-year survival (95%; 95% CI, 93%-96%; vs 89%; 95% CI, 87%-90%; P = . 007) but similar 20-year survival (34%; 95% CI, 31%-38%; vs 32% 95% CI, 28%-35%; P = . 90).. Witnesses do not appear to be at increased risk for surgical complications or long-term mortality when comparisons are properly made by transfusion status. Thus, current extreme blood management strategies do not appear to place patients at heightened risk for reduced long-term survival.

Topics: Aged; Anemia; Antifibrinolytic Agents; Blood Transfusion; Cardiac Surgical Procedures; Erythropoietin; Female; Hematinics; Humans; Jehovah's Witnesses; Length of Stay; Male; Middle Aged; Outcome Assessment, Health Care; Perioperative Care; Postoperative Complications; Research Design; Survival Analysis; Time Factors; Transfusion Reaction; Treatment Refusal; United States

Calvarial remodeling is typically associated with significant blood loss. Although preoperative erythropoiesis-stimulating agents have proven to significantly decrease the need for blood transfusions, recent data in adults have raised concerns that elevating hemoglobin levels greater than 12.5 g/dl may increase the risk of thrombotic events. This study was designed to assess the risks of erythropoietin in the pediatric population.. Records were retrospectively reviewed from 2000 to 2008 at three major metropolitan children's hospitals of all children undergoing calvarial remodeling after receiving preoperative erythropoietin. Demographic and perioperative outcome data were reviewed, including transfusion reactions, pressure ulcer secondary to prolonged positioning, pneumonia, infection, deep vein thrombosis, cerebrovascular accident, pulmonary embolism, sagittal sinus thrombosis, pure red cell aplasia, and myocardial infarction.. A total of 369 patients met the inclusion criteria (mean age, 0.86±1.1 years). On average, three preoperative doses of erythropoietin were administered (600 U/kg). Iron was also supplemented. No complications associated with dosing were noted, there were no thrombotic events identified, and no other major complications were seen (i.e., death or blindness). Thirty-one patients (8.40 percent) experienced one or more postoperative complications. There was no significant correlation between hemoglobin levels greater than 12.5 g/dl and the occurrence of any noted complication.. With zero thrombotic postoperative complications, the authors estimate the risk of a thrombotic event in the pediatric population to be less than 0.81 percent (95 percent confidence). These data suggest that preoperative administration of erythropoietin in children undergoing calvarial remodeling does not appear to increase the incidence of thrombotic events or other significant complications.. Therapeutic, IV.

Topics: Blood Loss, Surgical; Erythropoietin; Female; Hematinics; Humans; Infant; Male; Orthopedic Procedures; Postoperative Complications; Preoperative Care; Retrospective Studies; Skull; Synostosis; Thrombosis; Treatment Outcome

Patients with renal graft dysfunction constitute an increasingly prevalent group of end-stage kidney disease (ESKD) patients that require dialysis therapy. These patients have special characteristics that set them apart from the ESKD general population. The aim of this study was to analyse the clinical condition and evolution of patients entering dialysis with a failed kidney graft at the time of restarting dialysis and over a year of therapy according to the K/DOQI guidelines, and to compare them with incidental patients with end-stage kidney disease. We also investigated whether the modality of kidney replacement therapy may determine the clinical improvement of transplant patients.. This is a retrospective observational study of 106 patients with ESKD followed up in the Ramon y Cajal Hospital. They were classified in two groups. Group one was made up of 50 failed native kidney patients who started dialysis between 2000 and 2009. Group two was comprised of 56 transplant patients with graft dysfunction who returned to dialysis between 1997 and 2009. We studied parameters of kidney function, anaemia, calcium-phosphorus metabolism, cardiovascular risk factors and nutritional status at the time both groups started on dialysis and one year later.. Both groups had a similar clinical status at the time they started on dialysis in most of the parameters analysed with the exception of anaemia. This was more severe in transplant patients, despite the fact that transplant patients received a higher dose of erythropoietin than non-transplant patients. One year later the main difference between both groups was the residual kidney function rate, higher in non-transplant patients. There were no significant differences in the parameters analysed in patients with a failed graft according to the modality of kidney replacement therapy.. Failed transplant patients start dialysis with more severe anaemia than patients entering dialysis for the first time. Twelve months later both groups present a similar clinical condition with the exception of residual kidney function, higher in failed native kidney patients. The method of dialysis treatment after kidney transplant failure did not have a bearing on the clinical improvement of our patients.

Topics: Adult; Aged; Anemia; Calcium; Cardiovascular Diseases; Chronic Disease; Darbepoetin alfa; Erythropoietin; Female; Follow-Up Studies; Graft Rejection; Humans; Kidney Diseases; Kidney Function Tests; Kidney Transplantation; Male; Middle Aged; Peritoneal Dialysis; Phosphorus; Postoperative Complications; Recurrence; Renal Dialysis; Retrospective Studies; Risk Factors; Treatment Outcome

MPG-EPO is a continuous erythropoietin receptor activator with a longer half-life than darbepoetin, hence requires less frequent injections. It has been successfully used in adults, but currently, there are no published data available for its use in children. This pilot study was performed to verify the effect of MPG-EPO on Hb levels in children. Twelve patients (age 6.4-17.2 yr) were treated with MPG-EPO as an individual "Heilversuch" according to German law after RTx. Five patients were switched from DA, and seven were naïve to erythropoietin. Over a period of six months, Hb levels were measured monthly. A median MPG-EPO dose of 2.5 μg/kg was administered intravenously in a single dose every four wk. The median Hb value increased in naïve patients from 9.9 to 11.2 g/dL (median, p = 0.004) and from 10.3 to 11.6 g/dL (median, p = 0.39) in patients switched from DA to MPG-EPO. No adverse events secondary to MPG-EPO therapy were detected. Our results indicate that a once-monthly injection of MPG-EPO is an effective treatment of anemia in children after renal transplantation. Larger randomized trials will have to confirm our findings.

Topics: Adolescent; Anemia; Child; Drug Carriers; Erythropoietin; Female; Ferritins; Glomerular Filtration Rate; Humans; Immunosuppressive Agents; Kidney Transplantation; Male; Polyethylene Glycols; Postoperative Complications; Recombinant Proteins; Transferrin; Treatment Outcome

Although endogenous erythropoietin secretion returns via the renal allograft a few hours following successful engraftment, anemia is a common early or late complication. In addition, anemia is a risk factor for ischemic heart disease and graft loss. We sought to determine risk factors for and the prevalence of severe anemia immediately posttransplantation (PTA).. This cross-sectional retrospective study performed between 2006 and 2009 enrolled 864 adult subjects of mean age 40.7±13.8 (range=6-75) years. On the basis of The World Health Organization criteria, a hemoglobin (Hb) level less than 11 g/dL for men and less than 10 g/dL for women was defined as severe anemia.. Severe anemia occurred frequently (62.7%) among these patients whose most common underlying disease was hypertension 311 (58.2%). Their mean Hb level was 9.9±1.8 g/dL at the time of hospital discharge, namely, almost 2 weeks after transplantation. More than 90% (n=778) of subjects received a kidney from a living donor. Immediate severe anemia associated with delayed graft function (DGF; P=.01), antithymocyte globulin (ATG)/antilymphocyte globulin (ALG) administration (P=.000), acute rejection (P=.000), recipient gender (P=.000), cold ischemic time (P=.01), pretransplant Hb (P=.000), posttransplant creatinine (P=.001), and acute rejection episodes (P=.000). Upon logistic regression analysis donor age (P=.04, confidence interval [CI]=0.7-0.9), recipient female gender (P=.009, CI=0.08-0.7), and ATG/ALG use (P=.009, CI=1.7-43.4) showed significant effects to cause severe PTA.. Immediate anemia after renal transplantation is a consequence of poor renal function. In addition, ATG/ALG use and DGF can induce severe PTA, which may play roles in ischemic heart disease and graft loss.

Topics: Adolescent; Adult; Aged; Anemia; Child; Cross-Sectional Studies; Erythropoietin; Graft Survival; Humans; Kidney Failure, Chronic; Kidney Transplantation; Middle Aged; Myocardial Ischemia; Postoperative Complications; Risk; Risk Factors

The only currently offered curative option for many patients with primary or secondary liver tumors is the resection of hepatic tumors. The aim of this study was to evaluate the role of recombinant human erythropoietin (rhEPO) in liver protection and regeneration after subtotal hepatectomy in rats. Rats undergoing 70% hepatectomy received an intraperitoneal injection of saline (control) or rhEPO (4 U/g) 30 minutes prior to resection. Liver function was assessed by the measurement of the international normalized ratio (INR) levels, and hepatic injury was assessed by serum alanine aminotransferase and aspartate aminotransferase levels. Hepatic apoptosis was assessed by intrahepatic caspase-3 activity and morphological criteria. The regeneration capacity of remnant livers was assessed over 7 days with the regenerated liver/body weight ratio, immunohistochemistry markers of cell proliferation (Ki-67) and angiogenesis (von Willebrand factor), and phosphorylated extracellular signal-regulated kinase signaling. Two and 4 days after subtotal hepatectomy, the regenerated liver/body weight ratio was significantly higher in animals treated with rhEPO versus the control group (P < 0.005). Serum liver enzymes and INR levels on days 2 and 4 post-hepatectomy were significantly lower in animals pretreated with rhEPO in comparison with the control group (P < 0.005). No statistically significant difference was noted in intrahepatic hepatic caspase-3 activity, immunohistochemistry for caspase-3, or a terminal deoxynucleotidyl transferase-mediated deoxyuridine triphosphate nick-end labeling assay between the hepatectomized groups. In the rhEPO-pretreated group, the mitotic index, Ki-67 and von Willebrand factor expression, and extracellular signal-regulated kinase activity were significantly higher on day 2 post-hepatectomy (P < 0.05) in comparison with the control group. In conclusion, rhEPO treatment may offer a unique beneficial dual-function strategy for hepatic protection and regeneration immediately after subtotal hepatectomy in rats.

Topics: Alanine Transaminase; Animals; Apoptosis; Aspartate Aminotransferases; Blotting, Western; Caspase 3; Erythropoietin; Hepatectomy; Humans; Immunohistochemistry; In Situ Nick-End Labeling; International Normalized Ratio; Ki-67 Antigen; Liver; Liver Regeneration; Male; Organ Size; Postoperative Complications; Rats; Rats, Wistar; Recombinant Proteins; Reperfusion Injury; von Willebrand Factor

To critically examine the cardiovascular and thromboembolic risks associated with erythropoietin stimulating proteins (ESPs) in men with normal hemoglobin levels undergoing open radical retropubic prostatectomy.. Between October 1, 2000, through December 31, 2006, a total of 1308 men underwent open radial retropubic prostatectomy by a single surgeon. Of these men, 1095 received preoperative ESPs. Hematocrit levels measured at baseline, immediately before anesthesia induction and at hospital discharge, were prospectively entered into a database. Thromboembolic and cardiovascular complications were prospectively captured during the hospitalization and after surgery.. The mean Delta preoperative hematocrit level was 5.9 g/dL. The pre-anesthesia induction hematocrit level was 49.2%. Hospital discharge hematocrit level was 33.6 g/dL. The overall risk of cardiovascular and thromboembolic complications in men receiving ESP were 0.55% and 0.45%, respectively. The risk of cardiovascular and thromboembolic complications were independent of the Delta in preoperative hematocrit or the absolute level of the pre-anesthesia induction hematocrit.. ESPs represent a safe and effective preoperative blood management strategy for men undergoing open radical retropubic prostatectomy.

Topics: Aged; Analysis of Variance; Cardiovascular Diseases; Cohort Studies; Erythropoietin; Follow-Up Studies; Hematocrit; Hemoglobins; Humans; Male; Middle Aged; Postoperative Complications; Preoperative Care; Prospective Studies; Prostatectomy; Prostatic Neoplasms; Recombinant Proteins; Risk Assessment; Survival Rate; Thromboembolism; Treatment Outcome

Topics: Anemia; Cardiovascular Diseases; Erythropoietin; Humans; Male; Postoperative Complications; Preoperative Care; Prognosis; Prostatectomy; Prostatic Neoplasms; Recombinant Proteins; Risk Assessment; Survival Analysis; Thromboembolism

Although microsurgery has rapid expanded, problems related to microarterial anastomosis continue. Cigarette smoking is one of the major risks for anastomosis by increasing platelet adhesion, and its effects on endothelial cells. Aim of this article is to study the negative effects of cigarettes on microarterial anastomosis line, and to investigate the protective effects of recombinant human erythropoietin (rHuEPO).Ninety-six Sprague-Dawley male rats were divided into 3 groups: group 1 was the control. Rats in groups 2 and 3 were exposed to cigarette smoke starting 21 days prior to surgery for 3 times a day. In group 3, additional 150 IU/kg rHuEPO was given via subcutaneously every 48 hours after microvascular anastomosis, femoral arterial samples, and blood samples were taken for assessment at 1st, 3rd, 5th, and 7th day. Intimae/media ratios were calculated for morphologic analyses.On morphologic analysis of femoral arteries there were statistically significant differences for all 3 groups at 1st, 3rd, 5th, and 7th days (P < 0, 05). The group that made differences was group 2, according to one-way analysis of variance within 3 groups in all days.Smoking decreases endothelial cells healing and causes more thromboses. rHuEPO can prevent these negative effects of smoking.

Topics: Anastomosis, Surgical; Animals; Arterioles; Endothelial Cells; Erythropoietin; Femoral Artery; Injections, Subcutaneous; Male; Microsurgery; Postoperative Complications; Rats; Rats, Sprague-Dawley; Recombinant Proteins; Risk Factors; Smoking; Thrombosis

Haemolytic anaemia is a well-recognised but rare complication of heart-valve prostheses. The authors report a case of an 80-year-old woman with severe haemolytic anaemia previously treated with valvuloplasty and annuloplasty without rings. To our knowledge, no cases of haemolysis have been described with this type of surgery.

Topics: Aged, 80 and over; Anemia, Hemolytic; Atrial Fibrillation; Diagnosis, Differential; Echocardiography; Echocardiography, Transesophageal; Erythrocyte Indices; Erythrocyte Transfusion; Erythropoietin; Female; Hematocrit; Hemoglobinometry; Humans; Mitral Valve Annuloplasty; Mitral Valve Insufficiency; Postoperative Complications; Psychotic Disorders; Recombinant Proteins; Respiratory Insufficiency; Suture Techniques; Ultrasonography, Doppler, Color

In humans elective spine surgery can cause iatrogenic spinal cord injury (SCI). Efforts for neuroprotection have been directed to avoid mechanical injury by using intraoperative monitoring and improving surgical techniques. There is, however, uncertainty regarding the efficacy of neuroprotective drugs.. Experimental study on the effectiveness of pharmacological neuroprotection in an animal model of spine surgery simulating anticipated mechanically induced neurological damage.. To compare the efficacy of four drugs to protect against the neurological effects of iatrogenic SCI.. Research Unit for Neurological Diseases, IMSS-Proyecto Camina, Mexico City, Mexico.. Erythropoietin, melatonin, cyclosporine-A and methylprednisolone were administered to rats before, during and after controlled spinal cord contusion of mild intensity. Dosage was in accordance with their pharmacokinetic properties and experience gained with experimental SCI. Drug efficacy was assessed by motor function recovery over a period of 6 weeks and by spinal cord morphometry.. Compared with animals treated with saline, the drug-treated groups showed no differences in their locomotor performance, nor in the amount of spared cord tissue. Notably, spontaneous activity was significantly reduced in rats treated with cyclosporine-A.. The neuroprotectant drugs used here perioperatively did not reduce the extent of neurological damage in a model simulating iatrogenic SCI. Therefore, for now, the only protection in elective spine surgery is avoidance of primary injury altogether.

Topics: Analysis of Variance; Animals; Cyclosporine; Disease Models, Animal; Erythropoietin; Female; Locomotion; Melatonin; Methylprednisolone; Neuroprotective Agents; Postoperative Complications; Rats; Rats, Long-Evans; Recombinant Proteins; Recovery of Function; Spinal Cord; Spinal Cord Injuries; Time Factors

The laboratory mouse is commonly used as a sophisticated model in biomedical research. However, experiments requiring major surgery frequently lead to serious postoperative complications and death, particularly if genetically modified mice with anatomical and physiological abnormalities undergo extensive interventions such as transmitter implantation. Telemetric transmitters are used to study cardiovascular physiology and diseases. Telemetry yields reliable and accurate measurement of blood pressure in the free-roaming, unanaesthetized and unstressed mouse, but data recording is hampered substantially if measurements are made in an exercising mouse. Thus, we aimed to optimize transmitter implantation to improve telemetric signal recording in exercising mice as well as to establish a postoperative care regimen that promotes convalescence and survival of mice after major surgery in general.. We report an optimized telemetric transmitter implantation technique (fixation of the transmitter body on the back of the mouse with stainless steel wires) for subsequent measurement of arterial blood pressure during maximal exercise on a treadmill. This technique was used on normal (wildtype) mice and on transgenic mice with anatomical and physiological abnormalities due to constitutive overexpression of recombinant human erythropoietin. To promote convalescence of the animals after surgery, we established a regimen for postoperative intensive care: pain treatment (flunixine 5 mg/kg bodyweight, subcutaneously, twice per day) and fluid therapy (600 microl, subcutaneously, twice per day) were administrated for 7 days. In addition, warmth and free access to high energy liquid in a drinking bottle were provided for 14 days following transmitter implantation. This regimen led to a substantial decrease in overall morbidity and mortality. The refined postoperative care and surgical technique were particularly successful in genetically modified mice with severely compromised physiological capacities.. Recovery and survival rates of mice after major surgery were significantly improved by careful management of postoperative intensive care regimens including key supportive measures such as pain relief, administration of fluids, and warmth. Furthermore, fixation of the blood pressure transmitter provided constant reliable telemetric recordings in exercising mice.

Topics: Analgesics; Animals; Buprenorphine; Clonixin; Erythropoietin; Humans; Laboratory Animal Science; Mice; Mice, Transgenic; Physical Conditioning, Animal; Postoperative Care; Postoperative Complications; Surgical Procedures, Operative; Telemetry

The CREATE and CHOIR studies showed a higher risk for cardiovascular events associated with hemoglobin (Hb) values >13 g/dL in patients with stage 3-4 chronic kidney disease. In 2007, a stricter policy on the use of erythropoietin (EPO) was adopted at our center, with an Hb target of 11 to 12 g/dL and withdrawal or reduction of EPO when Hb was >12.5 to 13 g/dL. This study was designed to evaluate this new approach.. The study included patients under follow-up at the transplant outpatient clinic on December 31, 2006 (n = 725), and December 31, 2007 (n = 768). Data were compared between the study populations concerning renal function, Hb, use of EPO, and associated costs.. No significant differences in creatinine or Hb values were observed between the 2 groups (1.47 +/- 0.6 vs 1.42 +/- 0.9 mg/dL and 13.7 +/- 1.5 vs 13.7 +/- 1.6 g/dL, respectively). After implementation of the new protocol, the frequency of severe anemia (Hb <11 g/dL) increased (2% vs 4%; P = .10), the use of EPO decreased (22.1% vs 17.2%; P = .017), and the mean Hb of EPO-treated patients decreased (12.5 +/- 1.4 vs 11.9 +/- 1.0; P < .001). The Hb target (11-12 g/dL) was met in fewer than one third of patients, with no significant differences between the 2 study times.. A strict policy on EPO application reduces its use and the rate of patients with "excessive" Hb values (which are associated with increased cardiovascular risks), with an acceptable slight increase in severe anemia cases.

Topics: Adult; Anemia; Angiotensin-Converting Enzyme Inhibitors; Cardiovascular Diseases; Creatinine; Drug Administration Schedule; Erythropoietin; Female; Hemoglobins; Humans; Immunosuppressive Agents; Kidney Failure, Chronic; Kidney Transplantation; Male; Middle Aged; Postoperative Complications; Retrospective Studies; Risk Factors

Topics: Adolescent; Adult; Case-Control Studies; Child; Child, Preschool; Erythropoietin; Humans; Hypertension, Renovascular; Infant; Kidney Transplantation; Postoperative Complications; Retrospective Studies; Time Factors

There is increasing evidence that the anaemia of surgery is not iron deficient and is, therefore, unresponsive to iron supplementation. Oral iron is best avoided postoperatively, particularly in children, due to its dose-dependent side effects. We undertook a national survey of major paediatric orthopaedic surgical units in the UK to investigate the current management of postoperative anaemia with particular reference to iron supplementation.. Middle-grade doctors and charge nurses at 23 major paediatric orthopaedic units in the UK were contacted by telephone and a structured questionnaire was used to determine the management of postoperative anaemia in major hip, pelvic and spinal surgery.. Only one (4.3%) of the units surveyed had a formally established protocol for the management of postoperative anaemia. Only 10 out of 23 units (43.5%) did not routinely prescribe iron postoperatively. Of the remaining units, 11 commenced iron based on the postoperative haemoglobin level while only 2 used iron supplementation after investigation of serum haematinics for iron deficiency. One unit used erythropoietin in the treatment of postoperative anaemia.. Iron supplementation continues to be used in major paediatric orthopaedic surgery in the treatment of postoperative anaemia in the absence of iron deficiency. Given the current available evidence, we call for an end to the practice of routine iron supplementation for postoperative anaemia following major paediatric orthopaedic surgery in the UK.

Topics: Anemia, Iron-Deficiency; Child; Erythropoietin; Health Care Surveys; Humans; Iron; Orthopedic Procedures; Postoperative Care; Postoperative Complications; Professional Practice; United Kingdom; Vitamin B 12

Topics: Anemia; Epoetin Alfa; Erythropoietin; Female; Heart Valve Prosthesis Implantation; Hematinics; Humans; Middle Aged; Mitral Valve Stenosis; Postoperative Complications; Preoperative Care; Recombinant Proteins; Risk Factors; Treatment Outcome

mTOR inhibitors (imTOR) are immunosuppressive drugs that have a concentration-related effects on hematopoiesis, potentially resulting in anemia. The reason is uncertain, but a pathogenic link between sirolimus-induced anemia and the appearance of an inflammatory state was recently suggested. Because inflammation-related anemia is characterized by a functional iron deficiency, we studied whether everolimus influenced iron homeostasis.. We studied iron homeostasis in 43 patients after late introduction of everolimus into the immunosuppressive treatment. Thirty-seven patients (86%) were receiving mycophenolate. Hemoglobin concentration, red blood cell count, mean corpuscular volume, serum iron, ferritin, C-reactive protein levels, and transferrin saturation were evaluated 3 months before and 1, 3, and 6 months after the switch.. The percentage of anemic patients preconversion was 18.6% and it was 34.9% at 3 months and 18.6% at 6 months. We did not observe a significant reduction in hemoglobin, but there was increased red blood cell count after everolimus introduction, with a significant reduction in mean corpuscular volume. Serum iron and transferrin saturation levels were also markedly reduced after the switch, while ferritin serum concentrations remained stable. An improvement in renal function was observed.. The anemia caused by everolimus--microcytosis, low serum iron, despite high ferritinemia, and elevated C-reactive protein levels--was consistent with the anemia of a chronic inflammatory state. This alteration occurred within the first months postconversion and disappeared at 6 months. The combination of mycophenolate and everolimus seemed to be useful without significant secondary effects.

Topics: Anemia; C-Reactive Protein; Darbepoetin alfa; Erythrocyte Count; Erythropoietin; Everolimus; Ferritins; Hemoglobins; Hemostasis; Humans; Immunosuppressive Agents; Iron; Kidney Transplantation; Postoperative Complications; Sirolimus; Transferrin

This is a retrospective cohort study examining 61 patients with neurogenic scoliosis who underwent anterior and/or posterior spinal instrumentation at the age of 18 and younger.. The purpose of this study is to investigate this finding further by analyzing the effect of recombinant human erythropoietin (rhEPO) on hematocrit, transfusion and complication rates, and the length of intensive care unit (ICU) days in patients with neurogenic scoliosis.. The preoperative use of rhEPO has been shown to decrease perioperative transfusion requirements in many adult and pediatric patients. A recent study at our institution demonstrated the efficacy of rhEPO in pediatric idiopathic scoliosis patients, but suggested the possibility of an "erythropoietin resistance" in the pediatric neurogenic scoliosis population.. The patients' age at the time of surgery, gender, Cobb angle, erythropoietin administration and dosage, hematocrit levels, type of surgery, intraoperative blood loss, duration of surgery, number of vertebrae fused, comorbidities, complications, transfusion status, and the length of ICU days were collected.. Thirty-five (57.3%) children received preoperative rhEPO, whereas 26 patients (42.7%) did not receive rhEPO. The mean preoperative and discharge hematocrit levels in the patients treated with rhEPO were significantly higher than the non-rhEPO group (P = 0.05). There were no significant difference in likelihood of transfusion, complications, and the length of ICU days between the rhEPO and the non-rhEPO groups. A multivariate analysis demonstrated that the number of fused vertebral levels maintained its significance (P = 0.044) and surgical time had a trend toward significance (P = 0.051) in predicting likelihood of transfusion.. The use of rhEPO effectively stimulated erythropoiesis in these patients and yet demonstrated no significant clinical benefit in reducing the likelihood of transfusion in neurogenic patients in this study. More research is necessary to design a transfusion risk reduction protocols that will minimize the exposure of neurogenic scoliosis patients to allogeneic blood products.

Topics: Adolescent; Adult; Anemia; Blood Loss, Surgical; Blood Transfusion; Child; Child, Preschool; Cohort Studies; Erythropoietin; Female; Hematocrit; Humans; Male; Multivariate Analysis; Neuromuscular Diseases; Postoperative Complications; Predictive Value of Tests; Preoperative Care; Recombinant Proteins; Retrospective Studies; Scoliosis

Anemia after heart transplantation is common; however, there are scant data on etiology and treatment. This study evaluates type of anemia and the effects of erythropoietin therapy.. In 37 anemic heart transplant recipients (31 male/59.1+/-10.3 years/hemoglobin <12.0 g/dl), complete anemia work-up was performed including erythropoietin determination. For three months, 12 anemic patients with renal failure (9 male/64.1+/-13.6 years) were treated with 1-3x4000 IU of epoietin beta/week; treatment endpoints were hemoglobin levels and quality of life as determined by questionnaire.. In 31 patients no other cause of anemia than renal insufficiency (mean creatinine 1.9+/-0.9 mg/dl, mean calculated GFR 50.8+/-21.5 ml/min, no hemodialysis) was found; in 93.5% of these patients with renal insufficiency, measured erythropoietin levels were markedly lower than predicted [Beguin Y, Clemons GK, Pootrakul P, Fillet G. Quantitative assessment of erythropoiesis and functional classification of anemia based on measurements of serum transferrin receptor and erythropoietin. Blood 1993; 81(4):1067-1076.]. There was an inverse correlation of hemoglobin levels with serum creatinine/creatinine clearance and a strong trend for inverse correlation of erythropoietin levels. All 12 patients treated with erythropoietin showed a significant increase in hemoglobin levels after three months returning to pre-treatment values within 3 months of cessation of therapy (before study 10.8+/-1.1 g/dl, end of study 14.1+/-1.7 g/dl, three months after end of study 11.6+/-2.1 g/dl; p<0.005). Quality of life was significantly improved in eight patients (75%).. Anemia after heart transplantation is associated with moderate renal failure and low erythropoietin levels in most patients. Erythropoietin therapy resulted in increased hemoglobin levels in all and improved quality of life in 75% of patients. Erythropoietin may be a superior marker of functional renal impairment after heart transplantation; its therapeutic substitution allows effective anemia management and improves quality of life.

Topics: Aged; Anemia; Creatinine; Erythropoietin; Female; Heart Transplantation; Humans; Male; Middle Aged; Pilot Projects; Postoperative Complications; Quality of Life; Recombinant Proteins; Regression Analysis; Renal Insufficiency

Studies on living donor kidney transplantation primarily address the recipients; few publications focus on kidney donors. The aim of the present study was to detect changes in and compensations of defined parameters of anemia and inflammation in the immediate postnephrectomy period. We included six living kidney donors who underwent an open anterior-extraperitoneal nephrectomy. We excluded donors with complications, such as significant blood loss or infection. Blood samples were taken before nephrectomy as well as on postoperative days 1, 3, 5, and 7, and at discharge for measurements of hemoglobin (Hb), serum erythropoietin (Epo), reticulocytes (Reti), pentraxin 3 (PTX3), and C-reactive protein (CRP). There was a significant decrease in Hb (>3 g/dL), reaching a maximum on day 3 followed by a significant threefold increase in Epo levels on day 5 and a nonsignificant elevation of Reti count. CRP increased approximately 80-fold on day 3. PTX3 showed a similar course, peaking on day 3 with an approximate 70-fold increase. After living donor nephrectomy, there was an unexpectedly pronounced inflammatory reaction in the absence of any signs of bacterial infection simultaneous with a significant decrease in Hb. These parameters improved during the hospital stay, in some cases they achieved the prenephrectomy level at discharge. These data may assist in interpreting laboratory results after nephrectomy among living kidney donors.

Topics: Aged; C-Reactive Protein; Creatinine; Erythropoietin; Female; Hemoglobins; Humans; Inflammation; Kidney; Living Donors; Male; Middle Aged; Nephrectomy; Postoperative Complications; Postoperative Period; Tissue and Organ Procurement; Treatment Outcome

The aim of our study was to determine the prevalence and predictive factors for post-transplant anemia (PTA) at 6 (M6) and 12 (M12) months after orthotopic liver-transplant (OLT) in a cohort of 97 consecutive patients.. Anemia was defined at M6 and M12 according to the World Health Organization criteria, i.e., a hemoglobin level of <12 g/dL for women and <13 g/dL for men. Immunosuppression relied on tacrolimus and steroids with or without mycophenolate mofetil.. Anemia was present in 64.5%, 50%, and 52.8% of patients before OLT and at M6 and M12, respectively. Of the anemic patients, 33% (M6) and 30.3% (M12) received recombinant erythropoietin therapy. In multivariate analysis, the independent predictive factors for anemia at M6 were mean corpuscular volume (<85 fl) at day 7, daily steroid dosage (<0.3 mg/kg), serum creatinine (>130 micromol/L), and hemoglobin level (<11 g/dL) 1 month after OLT (M1). Independent predictive factors for anemia at M12 were daily steroid dosage at M1 (<0.3 mg/kg), hematocrit at M1 (<33%), red blood cell count at M6 (<3.75 T/L), daily dosage at M1 of cyclosporine and tacrolimus, and OLT for causes other than alcohol abuse.. Anemia is highly prevalent within the first year post-OLT. This deserves further investigation and appropriate treatment.

Topics: Adult; Anemia; Creatinine; Cyclosporine; Erythrocyte Count; Erythropoietin; Female; Graft Rejection; Hemoglobins; Humans; Immunosuppressive Agents; Liver Transplantation; Male; Middle Aged; Multivariate Analysis; Postoperative Complications; Predictive Value of Tests; Prevalence; Retrospective Studies; Risk Factors; Tacrolimus; Time Factors

We sought to determine the prevalence and predictive factors for posttransplant anemia within the first year after orthotopic liver transplant (OLT) among 97 consecutive patients. Anemia was defined at months 6 and 12 according to the WHO criteria, that is, a hemoglobin (Hb) level of <12 g/dL for women and <13 g/dL for men. Immunosuppression relied on tacrolimus and steroids, with or without mycophenolate mofetil. Anemia was present in 64.5%, 50%, and 52.8% of patients pre-OLT versus 6 and 12. Thirty-three percent (month 6) and 30.3% (month 12) of anemic patients received recombinant erythropoietin therapy. A multivariate analysis revealed that the independent predictive factors for anemia at month 6 were mean corpuscular volume (<85 fL) at day 7, daily steroid dosage (<0.3 mg/kg), serum creatinine (>130 mumol/L), and Hb level (<11 g/dL) at month 1. Independent predictive factors for anemia at month 12 were daily steroid dosage at month 1 (<0.3 mg/kg), hematocrit at month 1 (<33%), red blood cell count at month 6 (<3.75 T/L), daily dosage at month 1 of cyclosporine or tacrolimus, and etiology of end-stage liver disease other than alcohol abuse. We concluded that anemia was highly prevalent within the first year of post-OLT. This observation deserves further investigation and appropriate treatment.

Topics: Anemia; Antiviral Agents; Creatinine; Erythrocyte Volume; Erythropoietin; Follow-Up Studies; Hemoglobins; Humans; Immunosuppressive Agents; Interferon alpha-2; Interferon-alpha; Liver Function Tests; Liver Transplantation; Polyethylene Glycols; Postoperative Complications; Predictive Value of Tests; Prevalence; Recombinant Proteins; Reoperation; Retrospective Studies; World Health Organization

Treatment of anemia in the perioperative period of major orthopedic surgery decreases the need for blood transfusion and improves perioperative outcomes. Use of epoetin alfa in this setting is FDA-approved and provides significant benefit to qualified and carefully chosen patients.

Topics: Anemia; Arthroplasty, Replacement; Blood Transfusion; Epoetin Alfa; Erythropoietin; Hematinics; Humans; Postoperative Complications; Preoperative Care; Recombinant Proteins; Risk

The purpose of this work was to assess the prognostic value of the need for erythropoietin (EPO) treatment at 6 months after transplantation. We retrospectively reviewed the outcomes of 143 consecutive cadaveric kidney transplants performed between January 2000 and April 2004, functioning at 6 months postransplantation. Patients were divided into two groups: group EPO6m (n = 24) received EPO treatment in the sixth month, and a control group (n = 119) did not receive EPO. Renal function deterioration (RFD) was considered to be a sustained decrease in creatinine clearance (CrCl) greater than 20% between the sixth month postransplant and the last visit. Mean follow-up was 38 +/- 16 months. The mean ages of the donor (57 +/- 9 vs 49 +/- 12 years; P = .001) and the recipient (59 +/- 12 vs 47 +/- 17 years; P = .000) were greater in the EPO6m group. Delayed graft function (83% vs 48%; P = .001) was more frequent in the EPO6m group. At 6 months after transplantation the EPO6m group showed lower hemoglobin (11.52 +/- 1.71 vs 13.32 +/- 1.69 g/dL; P = .000), higher serum creatinine (2.31 +/- 0.72 vs 1.65 +/- 0.53 mg/dL; P = .000), lower CrCl (33.53 +/- 10.83 vs 53.6 +/- 17.58 mL/min; P = .000), and similar proteinuria. RFD was more common in the EPO6m group (38% vs 10%; P = .026), with a different pattern of evolution of CrCl (-0.098 +/- 0.176 vs +0.093 +/- 0.396 mL/min/mo, P = .000). Multivariate analysis demonstrated that treatment with EPO at 6 months was the only predictor of RFD (RR 4.46; 1.58 to 12.58; P = .005). The need for EPO at 6 months postransplant was a good predictor of later renal allograft deterioration, more sensitive than serum creatinine or proteinuria.

Topics: Aged; Creatinine; Erythropoietin; Female; Graft Survival; Humans; Kidney Transplantation; Male; Middle Aged; Patient Selection; Postoperative Complications; Prognosis; Proteinuria; Recombinant Proteins; Retrospective Studies; Survival Analysis; Tissue Donors

Topics: Acute Disease; Anemia, Refractory; Antineoplastic Combined Chemotherapy Protocols; Combined Modality Therapy; Cytarabine; Erythropoietin; Etoposide; Follow-Up Studies; Granulocyte Colony-Stimulating Factor; Humans; Leukemia, Myeloid; Male; Methotrexate; Middle Aged; Mitoxantrone; Peripheral Blood Stem Cell Transplantation; Postoperative Complications; Primary Myelofibrosis; Recombinant Proteins; Transplantation Conditioning; Transplantation, Autologous; Whole-Body Irradiation

We examined whether women aged 60 years or older with ovarian cancer who were treated with surgery and postoperative chemotherapy are at higher risk of developing grade 4 hematological toxicity. Seventy-five patients were included: 34 patients aged < 60 years (group I) were compared with 41 patients aged > or =60 years (group II) after postoperative treatment with single-agent carboplatin or carboplatin/taxane combination chemotherapy. Secondary prophylaxis with granulocyte colony-stimulating factors was performed to avoid dose reduction and chemotherapy delay. A total of 450 chemotherapy cycles was completed. Anemia and thrombocytopenia were mild in both groups. Overall, grade 4 neutropenia developed in 41% (group I) and in 49% (group II) (p=0.51). Febrile neutropenia occurred in 12% and 2%, respectively (p=0.17). The carboplatin/taxane combination was associated with grade 4 neutropenia in 42% (group I) and 58% (group II) (p=0.21). Women > or =60 years are not at higher risk of developing severe myelotoxicity than their younger counterparts, particularly after treatment with carboplatin/taxane combination chemotherapy.

Topics: Adult; Age Factors; Aged; Anemia; Antineoplastic Agents; Carboplatin; Drug Therapy, Combination; Erythropoietin; Female; Granulocyte Colony-Stimulating Factor; Hematologic Diseases; Humans; Middle Aged; Neutropenia; Ovarian Neoplasms; Postoperative Complications; Recombinant Proteins; Retrospective Studies; Risk Factors; Taxoids; Thrombocytopenia

Post-transplant anemia is a widespread problem among pediatric renal transplant recipients. Many clinicians treat post-transplant anemia in a manner similar to treatment of anemia in dialysis patients, including the use of intravenous iron, such as sodium ferric gluconate (SFG). Data on pediatric dosing of SFG are limited to rare small series containing few or no renal transplant recipients. We conducted a retrospective chart review of practice patterns at our institution to evaluate doses used, hemoglobin response and adverse events. We identified 15 renal transplant recipients who received SFG during the 28-month study period. Data from 14 of these patients were available for analysis. Patients received between one and six doses of SFG to yield a total dose of 100-1000 mg or 2.7-23.7 mg/kg. The largest doses given during a single infusion ranged from 1.9 to 6.4 mg/kg. The mean hemoglobin level increased from 101 +/- 16 to 114 +/- 21 g/L (p = 0.0092) following SFG therapy. Adverse events were recorded for three patients. Treatment with SFG appears to yield some improvement in anemia in renal transplant recipients, but the paucity of published information on this topic highlights the need for stronger data, particularly with respect to pediatric patients.

Topics: Adolescent; Adult; Anemia; Child; Erythropoietin; Female; Ferric Compounds; Hemoglobins; Humans; Injections, Intravenous; Kidney Transplantation; Male; Postoperative Complications; Recombinant Proteins; Retrospective Studies

Prolonged deep hypothermic circulatory arrest is known to cause neurological injury. Hypoxia inducible factor, a transcription factor that mediates adaptive changes during hypoxia, is neuroprotective in models of ischemic brain injury, in part by upregulating erythropoietin. This study tested the hypothesis that upregulation of hypoxia inducible factor and erythropoietin by preconditioning with hypoxia or the hypoxia-mimetic agents deferoxamine and cobalt chloride would be neuroprotective in a piglet model of deep hypothermic circulatory arrest.. Anesthetized neonatal piglets were randomized to 4 preconditioning groups (15 per group): hypoxia, deferoxamine, cobalt chloride, or control (NaCl vehicle). Brain hypoxia inducible factor and erythropoietin contents were assessed by means of Western blotting at 3, 8, and 24 hours after treatment (n = 3 per time point). Twenty-four hours after treatment, 6 to 7 animals per group underwent cardiopulmonary bypass and 110 minutes of deep hypothermic circulatory arrest. After recovery, serial neurobehavioral examinations were conducted for 6 days, after which histopathologic brain injury and neuronal apoptosis (cleaved caspase 3) were assessed.. Erythropoietin expression was not significantly increased by any of the pretreatment strategies. In contrast, there was a significant upregulation of hypoxia inducible factor by pretreatment with deferoxamine and cobalt chloride (P = .002). Neurobehavioral measures revealed no significant differences in time to recovery or extent of injury. Examination of histopathologic brain injury in the hippocampus revealed that pretreatment with deferoxamine (0.4 +/- 0.3) and cobalt chloride (0.5 +/- 0.3) were associated with significantly less neuronal loss than pretreatment with hypoxia or control (2.8 +/- 0.5, P = .004). Finally, cleaved caspase 3 (a marker of apoptotic cell death) was also shown to be diminished in the cobalt and deferoxamine groups, but the difference was not significantly different from the value in the control group.. In contrast to hypoxia, deferoxamine and cobalt chloride preconditioning upregulated hypoxia inducible factor and were associated with histopathologic neuroprotection after exposure to cardiopulmonary bypass and prolonged deep hypothermic circulatory arrest.

Topics: Animals; Animals, Newborn; Circulatory Arrest, Deep Hypothermia Induced; Erythropoietin; Hypoxia-Inducible Factor 1; Neurons; Postoperative Complications; Swine; Up-Regulation

Anemia is common in patients with chronic kidney disease (CKD) and those who have received a kidney allograft. Anemia is most prevalent in kidney transplant recipients before and immediately after transplantation, but also can occur months after transplantation if the donor kidney begins to fail. Replacement therapy for CKD-related and posttransplantation anemia is effective through the administration of exogenous erythropoiesis-stimulating proteins. Darbepoetin alfa (Aranesp; Amgen Inc, Thousand Oaks, CA) is a unique erythropoiesis-stimulating protein that can be administered at an extended dosing interval relative to recombinant human erythropoietin because of its approximately 3-fold longer serum half-life. Although darbepoetin alfa has been shown to be an effective treatment for patients with anemia of CKD and anemia after kidney transplantation, limited data have been published showing efficacy in treating women with anemia of these conditions during pregnancy. We report a case of successful darbepoetin alfa treatment for severe anemia in a pregnant transplant recipient.

Topics: Adult; Anemia; Cesarean Section; Contraindications; Cyclosporine; Darbepoetin alfa; Erythropoietin; Female; Ferrous Compounds; Humans; Hydronephrosis; Immunosuppressive Agents; Kidney Transplantation; Nephrostomy, Percutaneous; Postoperative Complications; Pre-Eclampsia; Pregnancy; Pregnancy Complications, Hematologic; Pregnancy, High-Risk; Puerperal Disorders; Seizures; Sirolimus; Stents; Treatment Refusal

Recombinant human erythropoietin (EPO) is used widely to treat anemia in patients with chronic kidney disease, but the benefits of EPO use in patients with acute renal failure (ARF) are unclear. In vitro and animal studies suggest that EPO may promote renal recovery and decrease mortality in ARF.. We conducted a retrospective cohort study at a tertiary-care center to evaluate the use of EPO in 187 critically ill patients with ARF requiring renal replacement therapy.. Compared with patients not administered EPO (n = 116), patients administered EPO (n = 71) were significantly more likely to have baseline chronic kidney disease, have undergone vascular surgery, and have received intermittent hemodialysis, rather than continuous renal replacement therapy. In a propensity-adjusted analysis that controlled for differences between the 2 cohorts and baseline hemoglobin level, EPO use did not decrease the transfusion of packed red blood cells. Renal recovery was not more common in patients administered EPO: the odds ratio for renal recovery in the propensity-adjusted analysis was 0.63 (95% confidence interval, 0.30 to 1.3) with EPO use. In-hospital survival was more common in the EPO-treated group, but this potential benefit was not significant in propensity-adjusted analyses.. Although EPO use was not associated with a decrease in transfusion requirements or with renal recovery in our retrospective study, 37% of critically ill patients with ARF were treated with EPO at varying doses. A randomized controlled trial is needed to evaluate the potential benefits of EPO use in patients with ARF.

Topics: Acute Kidney Injury; Adult; Aged; Anemia; APACHE; Cohort Studies; Comorbidity; Critical Care; Critical Illness; Drug Evaluation; Erythrocyte Transfusion; Erythropoietin; Female; Hospital Mortality; Humans; Male; Middle Aged; Missouri; Postoperative Complications; Recombinant Proteins; Renal Dialysis; Renal Replacement Therapy; Retrospective Studies; Risk Factors; Treatment Outcome; Vascular Surgical Procedures

Topics: Erythropoietin; Humans; Optic Neuropathy, Ischemic; Orthopedic Procedures; Perioperative Care; Postoperative Complications

Current regular blood transfusion programs and chelation treatment have considerably improved survival of patients with thalassemia, which resulted in a larger proportion of adult patients. However, disease- and treatment-related complications in these patients progress over time, causing severe morbidity and shortened life expectancy. Stem cell transplantation still remains the only cure currently available for patients with thalassemia. This study updates transplant outcomes in 107 adult patients with median age of 22 years (range, 17-35 years) who received bone marrow transplantation (BMT) from human leukocyte antigen (HLA)-identical related donors between 1988 and 1996 (group A) and describes the results of BMT in 15 adult patients with median age of 21 years (range, 17-31 years) who were treated with a new treatment protocol (Protocol 26) between 1997 and 2003 (group B). The probability of survival, event-free survival, nonrejection mortality, and rejection for group A patients were 66%, 62%, 37%, and 4%, respectively, with a median follow-up of 12 years (range, 8.3-16.2 years). Group B patients treated with the new protocol had some improvement in thalassemia-free survival (67%) and lower transplant-related mortality (27%) than that of previous protocols. However, transplant-related mortality in these high-risk patients remains elevated. Current myeloablative BMT in adult patients is characterized by higher transplant-related toxicity due to an advanced phase of disease. Although this new approach to transplant adult patients with a reduced-dose intensity-conditioning regimen has improved thalassemia-free survival, transplant-related mortality in these high-risk patients remains elevated.

Topics: Adolescent; Adult; Azathioprine; Bone Marrow Transplantation; Busulfan; Chelation Therapy; Clinical Protocols; Combined Modality Therapy; Comorbidity; Deferoxamine; Disease-Free Survival; Erythrocyte Transfusion; Erythropoietin; Female; Follow-Up Studies; Graft vs Host Disease; Granulocyte Colony-Stimulating Factor; Hematopoietic Cell Growth Factors; Hemosiderosis; Humans; Hydroxyurea; Immunosuppressive Agents; Iron Chelating Agents; Life Tables; Liver Cirrhosis; Male; Phlebotomy; Postoperative Complications; Survival Analysis; Thalassemia; Transfusion Reaction; Transplantation Conditioning; Transplantation, Homologous; Treatment Outcome; Vidarabine

The National Kidney Foundation has developed guidelines for the diagnosis and classification of chronic kidney disease (CKD) but it is not known whether these are applicable to renal transplant recipients. This study determined the prevalence of CKD according to the stages defined in the guidelines, the complications related to CKD and whether the prevalence of complications was related to CKD stage in 459 renal transplant recipients. CKD was present in 412 patients (90%) and 60% were in CKD Stage 3 with a glomerular filtration rate (GFR) between 30 and 59 mL/min/1.73 m2. The prevalence of anemia increased from 0% in Stage 1 to 33% in Stage 5 (p<0.001). Hypertension was present in 86% and increased from 60% in Stage 1 to 100% in Stage 5 (p=0.02). The number of anti-hypertensives per patient increased from 0.7 in Stage 1 to 2.3 in Stage 5 (p<0.001). The number of CKD complications per patient increased from 1.1 in Stage 1 to 2.7 in Stage 5 (p<0.001). We conclude that CKD and the complications of CKD are highly prevalent in renal transplant recipients. The classification of renal transplant patients by CKD stage may help clinicians identify patients at increased risk and target appropriate therapy to improve outcomes.

Topics: Blood Pressure; Chronic Disease; Creatinine; Cross-Sectional Studies; Erythropoietin; Ferritins; Glomerular Filtration Rate; Hemoglobins; Humans; Hypocalcemia; Kidney Diseases; Kidney Transplantation; Ontario; Postoperative Complications; Prevalence; Renal Replacement Therapy; Retrospective Studies; Transferrin

Patients returning to hemodialysis (HD) after failure of their kidney transplant suffer from high morbidity and mortality rates. It is common practice to keep failed kidney transplants in place. It is not known if these failed kidney transplants induce an inflammatory state that contributes to morbidity and mortality. In a single facility, patients starting on HD with failed kidney transplant were identified (Group A) and screened for the presence of chronic inflammatory state. Those with clinical symptoms attributed to the failed allograft (Group A1) were not offered transplant nephrectomy unless deemed necessary during follow-up. Their clinical and laboratory data were followed up for 6 months. Similar data were obtained from a group of incident HD patients (Group B). Forty-three patients had a failed Kidney transplant (Group A). Of these, 29 comprised Group A1 and 14 Group A2. Group B comprised 121 patients. In comparison with Group B, Group A exhibited worse anemia and erythropoietin resistance index (ERI), had lower serum albumin and prealbumin, and higher CRP. Group A1 had lower Hb and higher ferritin, CRP, and ESR in comparison with Group A2. Following transplant nephrectomy, Group A1 had improvement in ERI, serum albumin, prealbumin, ferritin, fibrinogen, CRP, and ESR. At 6 months, Group A1 had higher Hb and serum albumin levels, and lower CRP and ERI in comparison with Group A2. Group B parameters showed no change during follow-up. Patients returning to HD following failure of their kidney transplant suffer from a chronic inflammatory state. Resection of failed transplants in symptomatic patients is associated with amelioration of markers of chronic inflammation. Transplant nephrectomy should be considered a treatment option for patients with failed kidney transplants, especially if they exhibit signs and symptoms of chronic inflammatory state.

Topics: Chronic Disease; Erythropoietin; Female; Humans; Inflammation; Kidney Transplantation; Male; Middle Aged; Nephrectomy; Postoperative Complications; Renal Dialysis; Treatment Failure

Topics: Anemia; Anemia, Iron-Deficiency; Erythropoietin; Female; Humans; Immunosuppressive Agents; Infections; Kidney Transplantation; Liver Failure; Male; Postoperative Complications; Retrospective Studies; Sex Characteristics

Cardiovascular disease is a leading cause of death among kidney transplant recipients. Anemia, a risk factor for cardiovascular complications among patients with chronic kidney disease, has not been well characterized in kidney transplant recipients. We performed a retrospective cohort study of the prevalence of and factors associated with anemia among 240 patients who underwent kidney transplantation at our institution. The mean hematocrit (Hct) rose from 33% at 1 month after transplantation to 40% at 12 months after transplantation. The proportion of patients with Hct < 36% was 76% at transplantation and 21% and 36%, 1 year and 4 years after transplantation, respectively. Six months after transplantation, women had higher likelihood (OR = 3.61) of Hct < 36%, while higher Hct at 3 months (OR = 0.67 for 1% higher Hct) and diabetes (OR = 0.14) were associated with a lower likelihood of Hct < 36%. Similar associations were seen 12 months after transplantation. Even among patients with Hct < 30%, only 36% had iron studies, 46% received iron supplementation and 40% received recombinant human erythropoietin. Awareness of factors associated with a lower Hct may prompt better anemia screening and management, potentially improving cardiovascular outcomes among kidney transplant recipients.

Topics: Adolescent; Adult; Anemia; Cohort Studies; Erythropoietin; Female; Glomerular Filtration Rate; Hematocrit; Humans; Iron; Kidney Diseases; Kidney Transplantation; Male; Middle Aged; Postoperative Complications; Retrospective Studies; Sex Factors; Time Factors

Topics: Adult; Cyclosporine; Drug Evaluation; Erythroid Precursor Cells; Erythropoietin; Humans; Immunosuppressive Agents; Kidney Transplantation; Kidney Tubules; Losartan; Middle Aged; Polycythemia; Postoperative Complications; Receptor, Angiotensin, Type 1; Receptors, Angiotensin; Renal Circulation; Treatment Outcome; Uric Acid

Recurrence of hepatitis C virus (HCV) infection after orthotopic liver transplantation is a major cause of graft failure. The aim of our study was to determine the safety, efficacy, and tolerability of combination therapy with interferon and ribavirin in the treatment of recurrent hepatitis after liver transplantation. Twenty-six patients (18 men) with histologically established HCV recurrence after liver transplantation for cirrhosis secondary to chronic HCV infection were treated with a combination of interferon alfa-2b (3 million units three times weekly) and ribavirin (800 to 1,000 mg/d). Dosage modifications were according to a standard protocol incorporating laboratory values and clinical side effects. Fifty percent of patients completed 1 year or more of therapy. On an intention-to-treat basis, nine patients (35%) showed an end-of-treatment virological response. Six of these nine patients completed greater than 6 additional months of follow-up, and all have had sustained virological responses. A histological response (decrease in histological activity index > or = 2) was seen in 75% of virological responders and 67% of nonresponders. Adverse events requiring dose modification or cessation of therapy occurred in 66% of patients. Adjuvant therapies used to support hemoglobin levels included erythropoietin and red blood cell transfusions. There were no independent pretreatment predictors of a virological response, perhaps because of the small sample size. Combination therapy with interferon and ribavirin may be beneficial in patients with recurrent HCV after liver transplantation. The majority of patients require dose modifications because of side effects. Histological response is common in virological nonresponders.

Topics: Adult; Aged; Anemia; Antiviral Agents; Clinical Protocols; Drug Therapy, Combination; Erythrocyte Transfusion; Erythropoietin; Female; Hepatitis C, Chronic; Humans; Interferon alpha-2; Interferon-alpha; Liver Transplantation; Male; Middle Aged; Polymerase Chain Reaction; Postoperative Complications; Recombinant Proteins; Recurrence; Ribavirin

Homologous blood transfusion (HBT) has the risk of an immunosuppressive effect and may adversely affect the prognosis of patients with carcinomas. Autologous blood transfusion (ABT) has not yet become a standard procedure in gastroenteric cancer surgery. We investigated the usefulness and problems of ABT combined with the use of recombinant human erythropoietin (rh-EPO).. An evaluation of autologous blood transfusion (ABT) combined with recombinant human erythropoietin (rh-EPO) treatment was conducted in 46 patients with hepatocellular carcinoma undergoing hepatectomy. Preoperative autologous blood donation (ABD) was accomplished for 25 of the 46 patients. The preoperative changes in hemoglobin and hematocrit in relation to route of administration of erythropoietin were studied. In addition, intraoperative blood requirements and the postoperative complications for patients who predonated were compared with those of patients who underwent surgery without autologous predonation.. The proportion of patients not requiring additional homologous blood transfusions (HBT) during operation was significantly higher in the ABD group than in the non-ABD group (88% versus 38%). The incidence of postoperative complications was significantly higher in patients receiving HBT than in nontransfused patients and in those receiving ABT.. Preoperative autologous blood donation in combination with rh-EPO therapy markedly reduced the requirement for homologous blood transfusion during surgery in patients with hepatocellular carcinoma having hepatectomy.

Topics: Blood Transfusion, Autologous; Carcinoma, Hepatocellular; Case-Control Studies; Erythropoietin; Female; Hepatectomy; Humans; Incidence; Liver Neoplasms; Male; Middle Aged; Postoperative Complications; Recombinant Proteins

Several growth factors, such as growth hormone and insulin-like growth factor-1, have been used to reverse the high rate of catabolism observed either after an operation or during serious illness. We conducted a pilot study in Wistar rats in an attempt to assess whether regulatory peptides widely used in clinical practice, such as erythropoietin (EPO) and granulocyte macrophage colony-stimulating factor (GM-CSF), alone or in combination, might influence the metabolism after surgery. Forty animals were randomly allocated into four groups (one control group and three experimental groups; 10 animals per group). The rats in the control group received isotonic NaCl; the rats in one experimental group received recombinant human EPO (rHuEPO) at a dose of 500 IU/kg (EPO group) and those in another received recombinant GM-CSF at a dose of 20 microg/kg (GM-CSF group); in the fourth group, each animal received the two drugs in combination (EPO/GM-CSF group). In all groups, rats were given the drug(s) or NaCl daily for 15 days before the operation and for 7 days after the operation until they were killed. We estimated the body weight (g) and the hematocrit (%) on the first day of the experiment (baseline values) and on the seventh day after the operation, and we estimated the rate of healing and the breaking strength of the intestinal anastomosis on the day the rats were killed. At the end of the study we found that the body weight (median 250 g, minimum 230 g, maximum 270 g) and the levels of hematocrit (median 64%, minimum 60%, maximum 65%) were significantly increased in the EPO group (P < .001 and P < .005, respectively) as compared with the baseline values (median 217.5 g, minimum 200 g, maximum 250 g; median 51.5%, minimum 45%, maximum 55%, respectively). A similar significant increase in body weight (median 230 g; minimum 200 g; maximum 250 g) and hematocrit (median 64%; minimum 59%; maximum 67%) was found at the end of the study in the EPO/GM-CSF group (P = .01 and P < .005, respectively) as compared with the baseline values (median 210 g; minimum 200 g; maximum 250 g; median 50%, minimum 48%, maximum 54%, respectively). The breaking strength (in newtons (N)) statistically differed in the four groups (Kruskal-Wallis, P = .0008). A comparison between groups showed that the breaking strength had been significantly increased in the animals in the EPO group (median 2.18 N, minimum 1.98 N, maximum 2.44 N) as compared with those in the control group (median 1.66 N,

Topics: Animals; Body Weight; Erythropoietin; Granulocyte-Macrophage Colony-Stimulating Factor; Hematocrit; Humans; Male; Pilot Projects; Postoperative Care; Postoperative Complications; Preoperative Care; Rats; Rats, Wistar; Recombinant Proteins; Tensile Strength; Wound Healing

Topics: Acute Disease; Erythropoietin; Heart Transplantation; Humans; Immunocompromised Host; Male; Middle Aged; Parvoviridae Infections; Parvovirus B19, Human; Postoperative Complications

Posttransplant polycythemia (PTP) affects 6-30% of renal transplant recipients and can result in thromboembolic disease. The pathogenesis of PTP remains unknown and may be multifactorial. Although phlebotomy has previously been the treatment for PTP, drugs such as adenosine receptor antagonists or angiotensin-converting enzyme inhibitors can be used to control PTP.. The authors performed a prospective study of two different drugs to treat PTP: aminophylline and enalapril. Twenty-seven patients with PTP lasting more than 6 months were evaluated. During phase 1, aminophylline was compared with enalapril. The patients sequentially received aminophylline and enalapril during 12-week periods, intercalated by 12-week periods of no drugs. During phase 2, enalapril was administered for 12 weeks.. From January 1984 to December 1993, 110 of 333 patients with PTP lasting more than 6 months (33%) developed polycythemia, and 27 patients were included in the present study. In phase 1, aminophylline had no effect on PTP. Enalapril promoted an erythropoiesis inhibition, characterized by a decrease in hematocrit and an increase in iron stores and ferritin levels. After withdrawal of enalapril, the hematocrit increased and the iron stores decreased. In phase 2, there was a progressive reduction in hematocrit after the 4th week of therapy. The lowest hematocrit was observed in the 12th week and then enalapril was stopped, leading to a subsequent rise in hematocrit. Erythropoietin levels and renal function remained constant during all periods of both phases of the study.. The use of adenosine antagonists was ineffective to treat PTP in our series. However, treatment with enalapril promoted an erythropoiesis inhibition, demonstrated by a reduction in hematocrit, hemoglobin, red blood cell count, and reticulocyte count, associated with an increase in iron stores. This response occurred independently from erythropoietin levels or hemodynamic graft changes.

Topics: Adenosine; Adolescent; Adult; Aminophylline; Angiotensin-Converting Enzyme Inhibitors; Enalapril; Erythropoietin; Female; Hematocrit; Humans; Iron; Kidney Transplantation; Male; Middle Aged; Polycythemia; Postoperative Complications

Topics: Anemia; Animals; Animals, Genetically Modified; CD55 Antigens; Erythropoietin; Humans; Kidney Transplantation; Macaca fascicularis; Postoperative Complications; Recombinant Proteins; Swine; Transplantation, Heterologous

Secondary erythrocytosis is classically defined by an increase in erythropoietin (EPO) production. Despite increased levels of EPO often seen in secondary erythrocytosis, some of these forms such as that seen after renal transplantation remain undefined. Our group has recently investigated the in vivo function of insulin-like growth factor-I (IGF-I) in erythropoiesis both in humans and in a murine model of chronic renal failure. These data, and the recently recognized role of IGF-I in polycythemia vera, suggested that IGF-I might be involved in secondary erythrocytosis.. Renal transplant recipients who developed erythrocytosis after transplantation were compared to normal individuals and to renal transplant recipients without erythrocytosis. We measured fasting serum EPO and IGF-I in all three groups. Because binding proteins may modify IGF-I function, IGF-I-binding proteins (IGFBP) 1 and 3, major binding proteins of IGF-I, were also measured.. Renal transplant recipients have significantly elevated serum of IGF-I and IGFBP3 compared to normal individuals. When transplant recipients with and without posttransplant erythrocytosis were compared, similar levels of IGF-I were found; however, the group with erythrocytosis had significantly elevated IGFBP1 and IGFBP3. No other significant differences including EPO levels were found between the groups.. Erythrocytosis after renal transplantation represents an anomaly of both IGF-I and its major binding proteins. Further studies are under way to better define this dysregulation and determine whether IGF-I can play a more generalized role in secondary forms of erythropoiesis.

Topics: Adult; Aged; Erythropoietin; Female; Humans; Immunosuppressive Agents; Insulin; Insulin-Like Growth Factor Binding Protein 1; Insulin-Like Growth Factor Binding Protein 3; Insulin-Like Growth Factor I; Kidney Transplantation; Male; Medical Records; Middle Aged; Polycythemia; Postoperative Complications

Topics: Adolescent; Adult; Biomarkers; Cell Adhesion Molecules; Child; Child, Preschool; Cytokines; E-Selectin; Enzyme-Linked Immunosorbent Assay; Erythropoietin; Humans; Infant; Intercellular Adhesion Molecule-1; Interleukin-8; Liver Transplantation; Postoperative Complications; Predictive Value of Tests; Receptors, Interleukin-2; Vascular Cell Adhesion Molecule-1

Topics: Erythropoiesis; Erythropoietin; Female; Humans; Kidney Transplantation; Male; Polycythemia; Postoperative Complications; Sex Factors; Testosterone

Erythrocytosis represents a common complication in renal allograft recipients. Traditional therapies including phlebotomy and bilateral native nephrectomies are cumbersome for both the clinical personnel and the patient. Recently, pharmacological agents such as angiotensin converting enzyme inhibitor and theophylline have been proposed as effective therapies for post-transplant erythrocytosis (PTE). We have treated a PTE patient successfully with enalapril without any side effects and renal dysfunction after theophylline treatment showed no improvement in PTE. A decline in Ht levels was independent of the changes in Epo levels during enalapril treatment. Although the mechanism underlying the beneficial effect of enalapril remains undetermined, enalapril is recommended for the initial treatment of PTE.

Topics: Adenosine; Adult; Angiotensin-Converting Enzyme Inhibitors; Enalapril; Erythropoietin; Humans; Kidney Transplantation; Male; Polycythemia; Postoperative Complications; Theophylline

The authors related about a peculiar form of anemia found in some patients operated on oral cancer; these patients had an almost normal hematic situation before their operation. 63 patients, operated in the course of a year for oral cancer, have been studied by the authors; they have found in 14 cases (22.2%) a light anemia which regressed after a self blood transfusion, during the first week after the operation; in other 8 cases (12.7%) the anemia, which was more serious, persisted beyond the 7th day after the operation. Those 8 patients, suffering from more serious and persistent anemia, were treated from 7th to 21st day after the operation with iron, vitamin B12 and folic acid without any improvement. The hematic situation improved about 10 days after the end of treatment, probably as a result of spontaneous renewal of medullar haemopoietic activity. This anemia, is characterized by normochromia, normocytosis, reduced response of reticulocytes, sideropenia and hyperferritinaemia. The authors think that the pathogenesis of anemia after operation in neoplastic patients is caused by medullary insufficiency existing before the operation, connected with reduced erythropoietin production and emphasized by an operation that sometimes cause bleeding. Consequently the authors hypothesis the use of erythropoietin in the therapy of most severe anemia in neoplastic operated patients.

Topics: Anemia; Erythropoietin; Humans; Mouth Neoplasms; Postoperative Complications

Topics: Adult; Anemia; Cesarean Section; Erythropoietin; Female; Humans; Postoperative Complications; Recombinant Proteins

We studied production of erythropoietin (EPO) in long-term renal allograft recipients with posttransplant erythrocytosis (PTE). Among 951 recipients we found 74 patients with persistent elevation of hematocrit (Htc) value (female > 50%, male > 55%). However, only 63.5% of them had increased red-cell mass ( = "true" erythrocytosis). In all recipients with PTE known causes of secondary erythrocytosis were not found. EPO titer in peripheral blood was significantly higher in recipients with PTE (median 13.5 mIU/mL, range: 0.1-71.5 mIU/mL) as compared to healthy blood donors (median 5.75 mIU/mL, range: 0.1-19.5 mIU/mL) but not different from the group of renal allograft recipients without PTE (median 13.0, range 0.1-71.7 mIU/mL). However, EPO level measured in pretransplant sera was significantly higher in patients who developed PTE (median 16.4 mIU/mL, range: 1.0-281.2 mIU/mL) than in recipients without PTE (median 8.3, range: 1.0-50.3 mIU/mL). A significant difference in EPO level between systemic and effluent blood from native kidneys was found in 6 out of 14 recipients with PTE who underwent catheterization. After phlebotomy patients with PTE responded with higher increase in peak EPO titer than healthy blood donors (527 +/- 473% versus 194.5 +/- 44.2%, p < 0.05). Our results suggest that PTE develops spontaneously due to increased EPO production. Despite elevated EPO levels, regulation of EPO release remains preserved.

Topics: Adult; Blood Donors; Drug Therapy, Combination; Erythropoietin; Female; Hematocrit; Histocompatibility Testing; Humans; Immunosuppressive Agents; Kidney Transplantation; Male; Middle Aged; Polycythemia; Postoperative Complications; Reference Values; Retrospective Studies; Sex Characteristics

Topics: Blood Transfusion, Autologous; Erythropoiesis; Erythropoietin; Female; Humans; Kidney Transplantation; Male; Middle Aged; Postoperative Complications; Recombinant Proteins; Virus Diseases

The aim of our study was to evaluate bone marrow stimulation and bone marrow response to post-operative anaemia in children after open heart surgery. In 16 children (age 5.7 +/- 0.9 years, weight 20.1 +/- 3.2 kg) serum erythropoietin, haematocrit, reticulocyte count, ferritin, transferrin saturation and C-reactive protein were assessed perioperatively after cardiopulmonary bypass for surgical repair of atrial septal defect. Erythropoietin increased seven fold from 14 +/- 6.2 (7-30) to 80 +/- 49 (20-171) mU/ml (P < 0.05) and the reticulocyte count a 1.7-fold from 11.1 +/- 3.1 (6-19) to 18.4 +/- 5.9 (10-31) / 1000 (P < 0.05). Transferrin saturation was inversely correlated to C-reactive protein.. These findings suggest adequate bone marrow stimulation but an inadequate bone marrow response during the immediate perioperative period, caused by inhibition of erythropoesis by acute postoperative inflammation in children after open heart surgery.

Topics: Acute-Phase Reaction; Analysis of Variance; Anemia; Bone Marrow; Cardiopulmonary Bypass; Child; Child, Preschool; Erythropoiesis; Erythropoietin; Female; Heart Septal Defects, Atrial; Hematocrit; Hemodynamics; Humans; Iron; Male; Postoperative Complications; Regression Analysis; Reticulocyte Count

This report describes the peri- and postoperative management of a patient with a critical blood loss (hemoglobin of 22 g/l) as a consequence of a surgical intervention, i.e. a radical resection of an advanced malignant gynecological tumor. The patient refused autologous and homologous blood transfusions for religious reasons (Jehovah's Witness). During surgery, hemodilution and cell salvage were used. Postoperatively she developed coagulopathy and hemorrhage with the lowest hemoglobin value of 22 g/l. The patient recovered under a therapy regimen of recombinant human erythropoietin and parenteral iron. The hemoglobin values returned to the lower normal range within 4 weeks. Consequences of hypoxia could not be seen.

Topics: Adult; beta-Thalassemia; Blood Loss, Surgical; Carcinoma, Squamous Cell; Christianity; Combined Modality Therapy; Erythropoietin; Female; Hemodilution; Hemoglobinometry; Hemorrhage; Humans; Iron; Postoperative Complications; Religion and Medicine; Uterine Cervical Neoplasms

Recombinant human erythropoietin (r-HuEPO) was administered in 4 lung transplant recipients to treat chronic anemia beyond the immediate postoperative period. There were 2 males and 2 females with a mean age of 38 years (range 22-49). None of the patients had major infection or rejection problems, and no blood products were used. Because of different individual responses duration of therapy was 1 to 17 weeks (median 5) with a total dosage ranging from 8 to 36 x 10(3) IU (mean 21 x 10(3)). The median single dose was 58 IU/kg (range 36-100). Hemoglobin levels increased significantly from 9.1 +/- 0.2 to 12.7 +/- 0.3 g/dl (mean +/- SE; p < 0.01). There were no side effects. r-HuEPO is recommended in treatment of chronic anemia in lung transplant patients to save blood products and to exclude the potential risk of transfusion-transmitted viral infections.

Topics: Adult; Anemia; Azathioprine; Blood Transfusion; Dose-Response Relationship, Drug; Drug Administration Schedule; Erythropoietin; Female; Hemoglobinometry; Humans; Lung Transplantation; Male; Middle Aged; Postoperative Complications; Recombinant Proteins

Post-transplant erythrocytosis (PTE) has been increasingly recognized as a complication of kidney transplantation, and several risk factors have been defined. Recent evidence suggests renal function may also play a role in hematological recovery after transplantation and risk of PTE. In this study of kidney transplant recipients (n = 123), simultaneous Tc99m DTPA GFR (n = 710) and hemoglobin levels were compared with possible clinical determinants. The frequency histogram of post-transplant hemoglobin was bell-shaped and continuously distributed above and below the arbitrary definition of PTE, suggesting that PTE is not a separate disease entity. Hemoglobin reached a plateau at 12 months after transplantation and was correlated with isotopic GFR (r = 0.46, p < 0.001). This consistent and statistically independent relationship became prominent 3 months after transplantation. Hemoglobin was independently predicted by multivariate analysis by time after transplantation, presence of polycystic renal disease, greater serum albumin and reduced serum urea (which in turn were reflected by number of infective and rejection episodes), shorter kidney anastomosis time and a higher GFR, but not by immunosuppressive therapy. Rejection or infection episodes impaired hematological recovery. The independent determinants of GFR included hematological recovery. The independent determinants of GFR included hemoglobin level, kidneys from young, male donors, fewer HLA-DR mismatches and rejection episodes, shorter time on dialysis and greater azathioprine dose. Renal function was not altered by therapeutic phlebotomy. Determination of hemoglobin level by both donor and recipient variables supports the relevance of tubular and glomerular function in control of erythrocystosis after renal transplantation. A role for renin-angiotensin mediation in the alteration of intraglomerular hemodynamics and erythropoietin secretion is postulated.

Topics: Adult; Erythropoietin; Female; Glomerular Filtration Rate; Graft Rejection; Hemoglobinometry; Histocompatibility Testing; Humans; Kidney Failure, Chronic; Kidney Function Tests; Kidney Transplantation; Male; Middle Aged; Polycystic Kidney Diseases; Polycythemia; Postoperative Complications; Renin-Angiotensin System; Risk Factors; Treatment Outcome

Preoperative autologous donation (PAD) of blood and administration of recombinant human erythropoietin (Epoetin alfa) are two strategies for increasing red blood cell (RBC) mass preoperatively. The success of PAD depends primarily on the patient's ability to manufacture new RBCs before surgery to replace those removed during PAD. Red blood cell manufacture depends in turn on adequate supplies of iron and the increased renal production of endogenous erythropoietin following PAD. Successful PAD also requires adequate time for regeneration of predonated RBCs. Parenteral administration of Epoetin alfa causes a dose-dependent stimulation of RBC production. Its use has been studied as an adjunct to PAD and as a method to enhance endogenous erythropoiesis without PAD. Several studies suggest that administration of Epoetin alfa, begun several days before surgery, may stimulate erythropoiesis and help decrease the number of RBC transfusions required postoperatively. The precise role of Epoetin alfa in the surgical setting is not yet established, and optimal dosage regimens have not been determined.

Topics: Aged; Anemia; Blood Transfusion, Autologous; Drug Administration Schedule; Elective Surgical Procedures; Erythrocyte Transfusion; Erythropoiesis; Erythropoietin; Female; Ferritins; Humans; Inflammation; Male; Osteoarthritis; Postoperative Complications; Preoperative Care; Recombinant Proteins

Topics: Amputation, Surgical; Bloodletting; Cadaver; Erythropoietin; Glomerulonephritis; Hematocrit; Humans; Hypertension, Renal; Ischemia; Kidney Transplantation; Leg; Male; Middle Aged; Polycythemia; Postoperative Complications; Renal Dialysis

Recombinant human erythropoietin (rHuEPO) is effective in correcting anemia in hemodialysis, peritoneal dialysis, and predialysis patients. Limited studies in patients with failing renal allografts suggest a similar efficacy but provide little information concerning benefits, dose requirements, or adverse events. This study examined these considerations in a group of 40 patients (18 men; 22 women) aged 40.3 +/- 13.8 yr with stable, chronic renal allograft failure. All patients had a hemoglobin < 95 g/L and a serum creatinine > 250 mumol/L at baseline. Patients received rHuEPO (50 U/kg sc) three times weekly for 24 wk along with iron po if serum ferritin was < 100 micrograms/L. Mean hemoglobin rose from 78.9 +/- 10.4 to 102.6 +/- 18.4 g/L after 24 wk. Mean rHuEPO dose at 24 wk was 129.8 +/- 81.9 U/kg per week. With oral iron supplementation only, serum ferritin fell throughout the 24 wk, whereas serum iron, transferrin saturation, and total iron-binding capacity remained stable. Quality of life was assessed by use of the general Sickness Impact Profile and the disease-specific Transplant Disease Questionnaire measures at baseline and every 8 wk during rHuEPO therapy. Significant improvement was noted in global Sickness Impact Profile scores and in four of five dimensions of the Transplant Disease Questionnaire. Serious adverse events were infrequent. No change in mean systolic or diastolic blood pressure was noted, although there was a significantly increased need for antihypertensive drugs in 18 patients (P = 0.0002). A significant inverse correlation was noted between baseline renal function and maintenance rHuEPO dose (r = -0.45; P < 0.05). Twelve patients returned to dialysis during the study.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Aged; Anemia; Erythropoietin; Female; Humans; Immunosuppressive Agents; Iron; Kidney; Kidney Failure, Chronic; Kidney Transplantation; Male; Middle Aged; Postoperative Complications; Quality of Life; Recombinant Proteins

Twelve patients presenting postoperative acute renal failure (ARF), developing after peritonitis, are subjected to follow-up study. A comparative assessment of the renal function and anemic syndrome is done during three different periods: immediately after the operative intervention, after renal failure development, and at treatment completed. For the purpose a number of indicators are monitored, namely: hemoglobin, hematocrit, erythrocytes, blood platelets, urea, creatinine, serum calcium and iron levels, diuresis and creatinine clearance (Ccr). Two patients are given human recombinant erythropoietin (rHuEpo). As demonstrated by the results, erythropoietin (Epo) deficiency is the underlying cause of concurrent anemia occurring in postoperative ARF; the anemia syndrome develops parallel to renal failure development. In patients given rHuEpo the anemia lends itself readily to control, renal failure subsides completely within shorter periods of time, and the incidence of hemorrhagic accidents is reduced.

Topics: Acute Kidney Injury; Aged; Anemia; Combined Modality Therapy; Erythropoietin; Female; Humans; Kidney; Male; Middle Aged; Peritonitis; Postoperative Complications; Recombinant Proteins

Topics: Adult; Anemia; Erythropoietin; Female; Humans; Hypopituitarism; Postoperative Complications; Recombinant Proteins

To examine the techniques and the outcome of liver transplantation with maximal conservation of blood products and to analyze the potential benefits or drawbacks of blood conservation and salvage techniques.. Case series survey.. Tertiary care, major university teaching hospital.. Four patients with religious objections to blood transfusions who were selected on the basis of restrictive criteria that would lower their risk for fatal hemorrhage, including coagulopathy, a thrombosed splanchnic venous system requiring extensive reconstruction, active bleeding and associated medical complications. All patients were pretreated with erythropoietin to increase production of red blood cells. All operations were performed at the same institution, with a 36-month follow-up.. Orthotopic liver transplantation that used blood salvage, plateletpheresis, and autotransfusion and the withholding of the use of human blood products with the exception of albumin.. Survival and postoperative complications, with the effectiveness of erythropoietin and plateletpheresis as secondary measures.. All patients are alive at 36 months after orthotopic liver transplantation. One patient, a minor (13 years of age), was transfused per a state court ruling. Erythropoietin increased the production of red blood cells as shown by a mean increase in hematocrit levels of 0.08. Platelet-pheresis allowed autologous, platelet-rich plasma to be available for use after allograft reperfusion. Three major complications were resolved or corrected without sequelae. Only one patient developed postoperative hemorrhage, which was corrected surgically. The mean charge for bloodless surgery was $174,000 for the three patients with United Network for Organ Sharing (UNOS) status 3 priority for transplantation. This result was statistically significant when these patients were compared with all the patients with UNOS status 3 priority during the same period who met the same restrictive guidelines (P < .05). Only 19 of 1009 orthotopic liver transplantations performed at our institution were similar according to the UNOS status and the fulfillment of the guidelines. The mean charge for these comparison patients was $327,000, 3.8% of which was related to transfusions.. Orthotopic liver transplantation without the use of blood products is possible. Blood conservation techniques do not increase morbidity or mortality and can result in fewer transfusion-related, in-hospital charges.

Topics: Adolescent; Adult; Blood Loss, Surgical; Christianity; Erythropoietin; Female; Follow-Up Studies; Hepatic Encephalopathy; Humans; Liver Transplantation; Male; Middle Aged; Plateletpheresis; Postoperative Complications; Preoperative Care; Reoperation; Time Factors

Topics: Erythropoietin; Hip Prosthesis; Humans; Postoperative Complications; Risk; Thrombophlebitis

Topics: Adult; Blood Pressure; Creatinine; Enalapril; Erythropoietin; Female; Follow-Up Studies; Hematocrit; Humans; Kidney Transplantation; Male; Polycythemia; Postoperative Complications; Time Factors

Topics: Angiotensin-Converting Enzyme Inhibitors; Blood Volume; Dipeptides; Erythropoietin; Hematocrit; Hemoglobins; Humans; Kidney Transplantation; Lisinopril; Polycythemia; Postoperative Complications

Topics: Adult; Blood Transfusion; Cesarean Section; Christianity; Emergencies; Erythropoietin; Female; Hemorrhage; Humans; Postoperative Complications; Pregnancy; Pregnancy Complications; Religion and Medicine

Topics: Enalapril; Erythrocyte Count; Erythropoietin; Female; Hematocrit; Hemoglobins; Humans; Kidney Transplantation; Male; Polycythemia; Postoperative Complications

After sporadic reports of renal graft artery thromboses, prophylaxis against thrombosis (PAT) was given to all of our r-HuEPO-treated patients (n = 35) during a period of 2 years. No thromboembolic events (TEE) occurred in the r-HuEPO-treated group receiving PAT. However, the PAT-protocol (500 ml dextran on days 0, 1, 3 and 5, followed by low doses of aspirin, 160-250 mg daily) resulted in a 54.3% incidence of bleeding complications, of which 22.9% were major (i.e., necessitating multiple transfusions or invasive procedures). A group of renal graft recipients (n = 83), who were not treated with r-HuEPO and were not given PAT, showed a 10.8% incidence of bleeding complications of which 2.4% major. Two cases of TEE were noted in the untreated group. The difference in bleeding complications between the two groups was statistically significant (0.025 > P > 0.01). The difference in TEE between the groups was not significant. We found no difference between the groups with regard to early and late graft function and the incidence of acute rejections. In summary, r-HuEPO treatment did not influence the prognosis in renal graft recipients. The use of PAT in the r-HuEPO-treated group resulted in a high incidence of bleeding complications. In consequence, we have abandoned the routine use of PAT in this patient group.

Topics: Adult; Erythropoietin; Humans; Kidney Transplantation; Postoperative Complications; Recombinant Proteins; Retrospective Studies; Thromboembolism; Treatment Outcome

Between 1971 and 1990, 251 kidney transplanted patients with a well functioning graft were evaluated to determine the frequency of post-transplant erythrocytosis (PTE). Thirty-one patients (13 percent) developed polycythaemia 10.6 +/- 10 months after transplantation. Thromboembolic complications occurred in 22 percent of the cases. The frequency of PTE was higher in males than in females (sex ratio: 7.2 vs 2.1; P < 0.05). Patients with renal dysplasia had a lower incidence of PTE (3 vs 22 percent; P < 0.05) as did those who had been treated with azathioprine (9.4 vs 19 percent; P < 0.05). None of the patients treated with recombinant erythropoietin before transplantation developed PTE during a mean follow-up of 15.1 +/- 4.5 months. The majority of polycythaemic patients had normal erythropoietin levels. These results show that there is an erythropoietin-independent proliferation due to an increased sensitivity of erythroid progenitors or to an erythroid stem cell stimulation by cytokines.

Topics: Adult; Azathioprine; Erythropoietin; Female; Humans; Kidney Transplantation; Male; Middle Aged; Polycythemia; Postoperative Complications; Retrospective Studies; Thromboembolism

Topics: Acute Kidney Injury; Adult; Anemia; Erythropoietin; Female; Hemolysis; Humans; Postoperative Complications; Transfusion Reaction

Topics: Adult; Antilymphocyte Serum; Blood Transfusion; Dose-Response Relationship, Drug; Erythropoietin; Female; Graft Rejection; Graft Survival; Histocompatibility Testing; HLA Antigens; Humans; Infusions, Intravenous; Isoantibodies; Kidney Transplantation; Male; Middle Aged; Postoperative Complications; Renal Dialysis; T-Lymphocytes; Tissue Donors

The change of cell-mediated immunity was studied in patients receiving open heart surgery with or without administration of recombinant erythropoietin (rEPO). Group I was not administered rEPO in 30 patients, and Group II was done intravenously with 200U/kg/day of rEPO for 6.4 +/- 2.4 days before operation and also for 7.2 +/- 3.6 days after operation in 20 patients. The ratio of reticulocyte increased in all patients receiving rEPO. In both groups the ratios of OKT3 and OKT4 positive T lymphocytes decreased significantly on postoperative day 1. However, the ratios in patients with rEPO increased more significantly than in those without rEPO. Lymphocyte blast formation which was indicated by PHA-SI (phytohemagglutinin stimulation index) increased after administration of rEPO. The postoperative PHA-SI in both groups showed similar changes. The level of interleukin-2 (IL-2) production increased after the administration similar to PHA-SI change. The level of it decreased on postoperative day 1 and increased on postoperative days 3 and 7. We administered 200U/kg/day of rEPO for 7 days in a patient with postoperative erythroderma after open heart surgery and the level of IL-2 production was found to also increase in patient according with recovery of symptom. In conclusion, our data suggested that the rEPO might effect on not only erythrocyte but also lymphocyte activation.

Topics: Adult; Aged; Dermatitis, Exfoliative; Erythrocyte Count; Erythropoietin; Heart Diseases; Humans; Immunity, Cellular; Interleukin-2; Lymphocyte Activation; Male; Middle Aged; Postoperative Complications; Recombinant Proteins; Reticulocytes

The efficacy and method of administration of recombinant human erythropoietin (EPO) in adult cardiac surgical patients when given preoperatively was evaluated. We used EPO intravenously (iv) with 40 mg ferric oxide for a total of consecutive 47 patients. The patients were divided into group A (n = 14; EPO 200 IU/kg iv 3 times a week from 3 weeks prior to surgery to 2 weeks after surgery, donation of 800 ml) and group B (n = 33; EPO 200 IU/kg iv everyday from 8 days prior to surgery to 2 weeks after surgery, donation of 400 ml). Control groups were group AO (n = 11; donation of 835 +/- 33 ml from 14.8 days prior to surgery) and group BO (n = 7; donation of 406 +/- 34 ml at 7.3 days prior to surgery). All the EPO-treated patients received no homologous blood transfusion while 2 of patients in group BO received some homologous blood transfusion. A hemoglobin change between pre-donation and surgery was +0.14 +/- 1.3 (g/dl) in group A, +0.04 +/- 1.0 (g/dl) in group B, -1.7 +/- 1.3 (g/dl) in group AO and -1.0 +/- 0.6 (g/dl) in group BO. In a comparison of post-surgical hemoglobin levels between group A and group B, we demonstrated that the level in group B, +2.1 +/- 1.8 (g/dl) was significantly higher than that in group A, +11.1 +/- 1.6 (g/dl) 2 weeks after surgery. There was no evidence to show an aggravation of anemia in the pre-surgical period in EPO-treated groups.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Anemia; Blood Transfusion, Autologous; Cardiac Surgical Procedures; Erythropoietin; Humans; Postoperative Complications; Recombinant Proteins

Erythrocytosis after renal transplantation confers risks of thromboembolic complications and therefore necessitates repeated phlebotomies and/or anticoagulation therapy. Erythropoietin production from the retained native kidneys is one aetiological possibility for this condition. During 1982-1987, 22 patients with renal transplants underwent bilateral nephrectomy because of erythrocytosis with a median duration of 13 months. The median follow-up time was 36 months. After nephrectomy, blood counts returned to normal in all patients; these remained normal in all but two patients, who relapsed with erythrocytosis after 6 and 18 months respectively. Concomitant hypertension was cured or improved in most cases. One patient had a myocardial infarction postoperatively. No other per- or postoperative complications occurred. The mean duration of hospital stay was 7.5 days. We consider bilateral nephrectomy of the native kidneys a safe and effective alternative in the management of post-transplant erythrocytosis.

Topics: Adult; Child; Erythropoietin; Hemoglobins; Humans; Kidney Transplantation; Middle Aged; Nephrectomy; Polycythemia; Postoperative Complications; Reoperation

Erythrocytosis occurs in 10 to 15 percent of renal-transplant recipients, and there is in vitro evidence that the production of erythropoietin is modulated by adenosine.. We prospectively evaluated the effects of theophylline, a nonselective adenosine antagonist, in eight patients with erythrocytosis after renal transplantation and in five normal controls.. After an eight-week course of theophylline treatment, the mean (+/- SEM) serum erythropoietin levels were significantly reduced in both the renal-transplant recipients (from 60 +/- 14 units per liter at base line to 9 +/- 7 units after treatment; P less than 0.05) and the normal subjects (from 6.9 +/- 0.8 units per liter at base line to 4.7 +/- 0.5 units per liter after treatment; P less than 0.05). Similarly, the hematocrits were reduced in both the transplant recipients (from 0.58 +/- 0.04 at base line to 0.46 +/- 0.03 after treatment; P less than 0.05) and the normal subjects (from 0.43 +/- 0.01 at base line to 0.39 +/- 0.01; P less than 0.05). In the renal-transplant recipients, red-cell mass was also reduced after eight weeks of theophylline (from 3197 +/- 82 ml at base line to 2273 +/- 69 ml after treatment; P less than 0.05). The previous requirement of weekly phlebotomy was eliminated in all recipients. Plasma and urinary cyclic AMP levels were not increased. These effects were reproducible when the subjects were rechallenged with theophylline after a recovery period.. Theophylline attenuates the production of erythropoietin in both normal subjects and patients with erythrocytosis after renal transplantation and may be useful in the treatment of the latter condition.

Topics: Adult; Cyclic AMP; Depression, Chemical; Erythropoietin; Female; Hematocrit; Humans; Kidney Transplantation; Male; Middle Aged; Polycythemia; Postoperative Complications; Prospective Studies; Theophylline

Sequential changes in serum erythropoietin (sEPO) levels were measured by radioimmunoassay in six patients receiving autologous rescue (AR) and 11 patients receiving an allogeneic bone marrow transplant (BMT) for malignant disease. Longitudinal studies showed an inverse relationship between sEPO and haemoglobin levels in the autologous rescue and allogeneic transplant patients throughout the 130 d post-transplant study period. Early post-conditioning EPO responses were normal for the haemoglobin level in both groups, but after day 14 post-transplant, erythropoietin production in response to anaemia became impaired in one autologous rescue patient and eight of the 11 allogeneic transplant patients. There was no clear association between late impairment of sEPO production and conditioning therapy, infection, graft-versus-host disease, immunosuppressive therapy or serum creatinine. Blood transfusion requirements were similar for both groups in the first month after transplantation, but from days 31 to 90 post-transplant, BMT patients required an average of 5.5 units per patient compared with 1 unit per patient for the autologous group. Marrow transplant procedures do not affect early EPO responses but may diminish late responses. The potential value of exogenous rHuEPO in hastening engraftment and decreasing transfusion requirements, particularly for those patients who appear to have impaired EPO responses, remains to be shown by clinical trials.

Topics: Adolescent; Adult; Bone Marrow Transplantation; Erythropoietin; Female; Hemoglobins; Humans; Leukemia; Longitudinal Studies; Male; Middle Aged; Postoperative Complications; Postoperative Period; Radioimmunoassay; Transplantation, Autologous; Transplantation, Homologous

50 consecutive patients with hip arthroplasty had acute normovolaemic haemodilution and intra- and postoperative autotransfusion using Autotrans, Dideco GmbH. 18 of 50 patients received homologous blood products additionally to autotransfusion (Hb less than 8 g/dl, hemodynamic instability). There was no evidence for coagulation disorders, hypoxia or hypovolaemia during the whole investigation period (until the 10th p.o. day) though in some cases haemoglobin-levels less than 7 g% were accepted. No variations of erythropoietin levels could be observed postoperatively, suggesting that acute anaemia alone does not affect erythropoiesis. Reticulocytes, however, increased significantly from the 4th postoperative day. There was no correlation between number of reticulocytes and erythropoietin levels. Lactate levels stayed within normal range during the whole investigation period thus indicating normal microcirculation. The present data demonstrate that postoperative anaemia can be tolerated even in elder patients if intravascular volume is kept constant (normovolaemia). In accordance with recent literature the course of erythropoietin levels seemed to prove that there was no functional reduction in oxygen-availability.

Topics: Anemia; Blood Transfusion; Blood Volume; Erythrocyte Count; Erythropoiesis; Erythropoietin; Female; Hemoglobinometry; Hip Prosthesis; Humans; Lactates; Lactic Acid; Male; Oxygen; Postoperative Complications; Reticulocytes

Topics: Acute Kidney Injury; Aged; Erythropoietin; Hemoglobins; Humans; Postoperative Complications

Risks inherent in the administration of blood products have increased efforts to avoid homologous transfusion. Although this has increased interest in autologous transfusion and intraoperative salvage, little attention has been focused on efforts to enhance endogenous erythropoiesis as a method of minimizing exposure to homologous blood. Recombinant human erythropoietin (rHuEPO) has been shown to enhance erythropoiesis. The purpose of this study is to evaluate the effect of rHuEPO, administered postoperatively, on a model of acute blood loss. Eleven adult male baboons were randomized into two groups. All animals underwent a laparotomy and an exchange transfusion, with 6% hetastarch, to a final hematocrit of 15%. Group I (N = 6) received 1,000 units/kg of recombinant human erythropoietin daily for the first 14 postoperative days. Group II (N = 5) received an equivalent volume of placebo. All animals were given supplemental vitamin B12, folate and 200% of shed iron, as iron dextran IV, after exchange transfusion. Response was observed for a period of 35 days. All animals survived the protocol. There were no adverse reactions to rHuEPO or surgical complications. The hematocrits were similar between groups at baseline and after exchange transfusion. The maximal rate of erythropoiesis was significantly faster in the rHuEPO group (2.1 vs. 1.3%/day; p less than 0.01). The time required to return to hematocrits of 30% (9.9 vs. 17.4 days, p less than 0.001) and to baseline hematocrits (11.9 vs. 32.1 days, p less than 0.01) were both significantly shorter in the rHuEPO group. The data show that rHuEPO accelerates the recovery from anemia in the postoperative setting. Acceleration of erythropoiesis represents another alternative to homologous transfusion.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Anemia; Animals; Biopsy; Blood Cell Count; Bone Marrow; Drug Evaluation, Preclinical; Erythrocyte Indices; Erythropoietin; Exchange Transfusion, Whole Blood; Hematocrit; Humans; Papio; Postoperative Complications; Recombinant Proteins; Time Factors

Topics: Adult; Erythropoietin; Female; Humans; Kidney Transplantation; Postoperative Complications; Thrombosis

Topics: Adult; Blood Volume; Diabetes Complications; Erythropoietin; Hematocrit; Humans; Kidney Transplantation; Male; Polycythemia; Postoperative Complications

Post-transplant erythrocythemia (PTE) is a common finding in renal allograft recipients, although the etiology of this disorder has not been clearly established. We identified 22 patients (9.8%) with PTE from among 225 renal transplant recipients followed for an average of 5.5 years. To characterize possible predisposing factors and to study the clinical significance of PTE, these patients were compared with a control group matched for age, race, sex and etiology of renal failure. Plasma volume (PV) and red blood cell mass (RBCM) were measured in the majority of patients with PTE. Peripheral serum erythropoietin (Ep) levels were determined in the majority of patients in the control and PTE groups. PTE occurred an average of 11.4 months after transplantation. Risk factors for the development of PTE were pretransplant hypertension, retention of native kidneys, higher pretransplant hematocrit, and diuretic use for treatment of post transplant hypertension. Ep levels in the PTE and control groups were not significantly different. Twenty of the 22 patients with PTE were receiving concurrent diuretic therapy, and hematocrits fell to normal levels in all of these patients following cessation or dose reduction of diuretic. No other treatment of PTE was utilized, excluding the phlebotomy of a single unit of blood from one patient. No thromboembolic complications were noted during the follow-up period. We conclude that PTE is frequently induced by overzealous diuretic therapy for treatment of post-transplant hypertension. Discontinuation or reduction of diuretic therapy results in resolution of PTE in nearly all patients. From this experience we have developed an algorithm for the investigation and management of PTE.

Topics: Adult; Diuretics; Erythrocyte Volume; Erythropoietin; Female; Humans; Hypertension; Kidney Transplantation; Male; Plasma Volume; Polycythemia; Postoperative Complications

Five patients, one woman and four men, aged 24 to 54 years, developed abnormally high hematocrits between 4 and 22 months after renal transplantation. In four patients, red cell mass was above normal and plasma volume below normal. In one patient, both red cell mass and plasma volume were below normal. The cause of the deranged plasma volume was not evident. Decreased plasma volume may either contribute to or may, in rare instances, be the only cause of apparent erythrocytosis in renal transplant recipients.

Topics: Adult; Erythropoietin; Female; Hematocrit; Hemoglobins; Humans; Kidney Transplantation; Male; Middle Aged; Plasma Volume; Polycythemia; Postoperative Complications

Improvement of erythropoiesis following successful human renal transplantation in eight patients was monitored by sequential measurements of haemoglobin, red-cell creatine, absolute reticulocyte count and estimates of serum immunoreactive erythropoietin (siEp). SiEp increased in five patients after transplant, in three cases almost immediately after a return to normal of plasma creatinine. The increase in siEp was followed by a rise in the absolute reticulocyte count and red-cell creatine and finally by an increase in the haemoglobin level. As the haemoglobin approached normal levels a decline in the absolute reticulocyte count preceded a fall in siEp levels. Red-cell creatine also fell, though more gradually than the reticulocyte count. Acute graft rejection (in two patients) was associated with a fall in siEp. Chronic rejection (in one patient) was associated with persistent increases in siEp, reticulocyte count and red-cell creatine; this patient subsequently developed erythrocytosis.

Topics: Adult; Anemia; Creatine; Erythrocyte Count; Erythropoietin; Female; Graft Rejection; Hemoglobins; Humans; Kidney Failure, Chronic; Kidney Transplantation; Male; Postoperative Complications; Postoperative Period; Reticulocytes

A patient with end-stage renal disease had erythrocytosis after kidney transplantation, with a hematocrit level that ranged between 52 and 60%. Selective catheterization of venous blood from his native kidneys and the transplanted kidney revealed a threefold increase of erythropoietin activity in blood from his own kidney over systemic blood and blood from the transplanted kidney. Bilateral nephrectomy cured the condition. Postoperative hematocrit and erythropoietin levels were within normal limits.

Topics: Adult; Erythropoietin; Humans; Kidney; Kidney Transplantation; Male; Nephrectomy; Polycythemia; Postoperative Complications; Transplantation, Homologous

We present here results of studies on four patients (three men, one woman) who had had cadaver renal transplants and in whom renal artery stenosis and hypertension developed. Erythropoietin-dependent erythrocytosis developed in association with these changes in the three men. All patients had stable renal function and the hypertension was well controlled. Absolute erythrocytosis thought to be secondary to local renal hypoxia due to decreased renal blood flow developed in two of the men. Erythrocytosis developed in the other man but his RBC mass was at the upper limit of normal. In these patients, we suspect that the erythropoietin-dependent erythrocytosis is secondary to intrarenal hypoxia due to renal artery stenosis. Erythrocytosis or elevated erythropoietin levels failed to develop in the woman despite severe renal artery stenosis. Possible reasons for this discrepancy are discussed.

Topics: Adult; Cadaver; Creatinine; Erythropoietin; Female; Hematocrit; Humans; Kidney Transplantation; Male; Polycythemia; Postoperative Complications; Renal Artery Obstruction; Renin; Transplantation, Homologous

The development of erythrocytosis following renal transplantation has been reported to be caused by a number of factors. These include acute and chronic rejection, hydronephrosis and renal artery stenosis. In this study, seven patients were noted to have erythrocytosis with hematocrits ranging between 53.5 and 66%. Serum erythropoietin levels were elevated and ranged between 11 and 60 mU/ml with a mean of 31.9 mU/ml in six of seven patients. Selective catheterization of veins of native and transplanted kidneys in three patients revealed mean serum levels of 40.9 and 13.0 mU/ml, respectively. This suggests that excess erythropoietin is being produced from the diseased native kidneys. Bilateral nephrectomy in one patient cured erythrocytosis and dropped systemic levels of erythropoietin (EP) to 6.1 mU/ml. In four of the remaining five patients, hematocrits came down spontaneously to within normal over a 1- to 3-year period. Consequently, it appears that in a number of transplant patients the retained diseased kidneys, having lost all excretory and concentrating function, may remain capable of functioning as endocrine erythropoietin-producing organs.

Topics: Erythropoietin; Hematocrit; Humans; Kidney; Kidney Transplantation; Polycythemia; Postoperative Complications; Transplantation, Homologous

Topics: Adult; Bloodletting; Cadaver; Creatinine; Erythrocyte Count; Erythropoietin; Female; Hematocrit; Hemoglobins; Humans; Kidney Transplantation; Male; Polycythemia; Postoperative Complications; Tissue Donors; Transplantation, Homologous

Topics: Adrenal Cortex Hormones; Azathioprine; Blood Cell Count; Creatinine; Dactinomycin; Erythropoietin; Graft Rejection; Hippurates; Humans; Hypercholesterolemia; Immune Tolerance; Immunosuppression Therapy; Kidney Function Tests; Kidney Transplantation; Postoperative Complications; Time Factors; Transplantation Immunology; Transplantation, Homologous; Urination Disorders

Topics: Adult; Erythropoiesis; Erythropoietin; Humans; Kidney; Kidney Transplantation; Male; Nephrectomy; Polycythemia; Postoperative Complications; Transplantation, Homologous

Topics: Erythropoiesis; Erythropoietin; Female; Hemolysis; Histocompatibility; Humans; Kidney Transplantation; Male; Polycythemia; Postoperative Complications; Transplantation Immunology; Transplantation, Homologous

Topics: Animals; Erythropoiesis; Erythropoietin; Hematologic Diseases; Nephrectomy; Postoperative Complications; Rats; Testosterone

Topics: Animals; Erythropoietin; Hypertrophy; Kidney; Kidney Diseases; Nephrectomy; Postoperative Complications; Rats; Tissue Extracts

Topics: Blood Transfusion; Bone Marrow; Erythropoiesis; Erythropoietin; Female; Humans; Mediastinal Neoplasms; Middle Aged; Neutrophils; Postoperative Complications; Prednisone; Pyelonephritis; Radiography; Thymectomy; Thymoma; Thymus Gland

Following the successful replacement of diseased kidneys by renal homotransplants, regression of the anemia of chronic renal disease was found in five patients. Increased erythropoietic-stimulating activity was demonstrated in the serum of one patient seven weeks after renal transplantation when he suffered a severe hemorrhage. It is postulated that a renal homotransplant can produce enough erythropoietin to maintain a normal hemoglobin value and to respond to the stimulus of a sudden hemorrhage.

Topics: Anemia; Epoetin Alfa; Erythrocyte Count; Erythropoiesis; Erythropoietin; Hemoglobins; Hemorrhage; Humans; Kidney Diseases; Kidney Failure, Chronic; Kidney Transplantation; Male; Postoperative Complications; Reticulocytes; Transplantation, Homologous